2025 HCPCS code H0035

This HCPCS code represents mental health partial hospitalization treatment lasting less than 24 hours.

Adhere to all relevant HCPCS coding guidelines, payer-specific instructions, and local coverage determinations. Ensure accurate documentation supports all reported services.

Modifiers may be applicable depending on the circumstances of service delivery (e.g., KX for met medical necessity requirements, etc.). Consult payer guidelines for specific modifier rules.

Medical necessity for H0035 is established when the patient's condition requires a structured, intensive mental health treatment program but does not necessitate 24-hour inpatient care.Documentation should demonstrate the need for the intensity of services provided and the appropriateness of the partial hospitalization setting.

The clinical responsibility rests with the psychiatrist, therapist, or other qualified mental health professional leading the partial hospitalization program.This involves providing assessments, treatment planning, delivering services, and monitoring the patient's progress.

IMPORTANT S0201 is sometimes used as an alternative code for similar services.

In simple words: This code is used when someone gets intensive mental health help in a hospital or similar place for less than a full day. It's like a less intense version of being in the hospital full-time, but still involves lots of treatment and support.

H0035 is a HCPCS Level II code that describes mental health partial hospitalization services provided for less than 24 hours as part of a structured treatment program.These services are intensive, comparable to inpatient programs, but delivered in a setting where the patient is not present for a full 24-hour period.Services may encompass therapy, psychiatric assessment, medication management, substance abuse counseling, and other supportive interventions to aid reintegration into the community.Partial hospitalization is appropriate when the patient's condition doesn't warrant 24-hour inpatient care but necessitates a structured daytime program exceeding the intensity of day treatment or social rehabilitation programs.

Example 1: A patient experiencing an acute exacerbation of schizophrenia, not requiring 24-hour observation, receives 6 hours of daily therapy, medication management, and skills training in a partial hospitalization program., A patient with severe depression and suicidal ideation, but without immediate risk of self-harm, participates in a 4-hour partial hospitalization program focusing on cognitive behavioral therapy, medication management, and crisis intervention skills., An individual with bipolar disorder in a manic episode who requires close supervision but not 24-hour monitoring attends a structured 8-hour partial hospitalization program combining medication management, group therapy, and mood stabilization strategies.

Comprehensive clinical records documenting the patient's diagnosis, treatment plan, daily progress notes detailing services rendered, and discharge summary.Documentation should support medical necessity, including justification for partial hospitalization rather than less intensive or more intensive care.

** State Medicaid agencies may have specific requirements for using H codes. Always consult the relevant payer guidelines for accurate billing practices.Consider using alternative code S0201, depending on payer policy and service delivered.

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