H0015: Alcohol/Drug Intensive Outpatient Billing

What Is H0015?

H0015 is a HCPCS Level II code for intensive outpatient treatment of alcohol or drug use disorders. It covers structured programming that typically runs 9 to 19 hours per week across 3 or more days. Reimbursement varies by state: $100 to $300 per day (per diem) or $30 to $75 per hour depending on the Medicaid plan's billing methodology. H0015 is distinct from IOP billing using standard mental health codes.

Billing Rules

1. Bill H0015 per day or per hour based on your state Medicaid plan's methodology. Per diem states require a minimum number of hours per day (typically 3 hours).
2. The patient must have a primary substance use disorder diagnosis (ICD-10 F10-F19) and meet medical necessity criteria for intensive outpatient level of care (ASAM Level 2.1).
3. Services must include a combination of group therapy, individual counseling, psychoeducation, and case management within the same program day.

Documentation Requirements

Each program day requires: attendance record with check-in/check-out times, services provided (group topics, individual sessions, education modules), the patient's participation level, progress toward treatment goals, and discharge planning updates. State auditors verify that the minimum hours-per-day threshold was met for each billed unit.

Common Denials

CO-50 occurs when the patient's plan does not cover intensive outpatient or when the patient does not meet ASAM 2.1 criteria. CO-39 flags exceeded benefit limits. CO-29 applies when claims are submitted after the filing deadline. Verify benefits and authorization before the patient starts the program. See substance abuse billing for related guidance.