HCPCS code H2013 – Psychiatric health facility per diem

Key takeaways

H2013 reports one day of psychiatric health facility service, so each covered day is billed as one unit.

Medicare does not pay H2013 (coverage code I), so state Medicaid programs set its rates, rules and modifiers.

California Medi-Cal pairs H2013 with the HE modifier for services in a licensed psychiatric health facility.

Partial hospitalization belongs on H0035 and day treatment on H2012, so neither program should be billed as H2013.

Pabau, the practice software we build, keeps authorizations, treatment plans and daily notes on one patient record, so each billed day is easier to defend.

HCPCS code H2013 covers one day in a psychiatric health facility

HCPCS code H2013 is the Level II code for psychiatric health facility service, per diem. The Centers for Medicare and Medicaid Services (CMS) added it on April 1, 2003. It belongs to the H-code series of HCPCS codes, which state Medicaid agencies use for behavioral health services.

The code describes a facility day rather than a single session. One unit equals one day of care, and the facility bills that day instead of each service delivered inside it.

A psychiatric health facility is a setting each state defines in its own licensing law. In California, it is a facility licensed by the Department of Health Care Services that provides 24-hour inpatient care for people with mental health disorders. Its required services include psychiatry, psychiatric nursing and social work.

H2013 is not a partial hospitalization code. Partial hospitalization is H0035, and behavioral health day treatment is H2012, billed per hour. Mixing these codes up is the most damaging error on an H2013 claim, because the whole claim then describes the wrong service.

What H2013 covers and what it leaves out

As a per diem code, H2013 pays for the facility’s day of care. Which professional services that daily rate includes is a state decision. Check your state manual before adding a second claim line for the same date.

These services have their own codes and are not billed as H2013:

• Mental health partial hospitalization of less than 24 hours (H0035)
• Behavioral health day treatment, billed per hour (H2012)
• Residential treatment without room and board, billed per diem (H0017 to H0019)
• Crisis intervention, billed per 15 minutes (H2011)
• Psychosocial rehabilitation, billed per 15 minutes (H2017)
• Skills training and development, billed per 15 minutes (H2014)

Acute hospital inpatient psychiatric stays follow the payer’s hospital billing rules. Those rules differ from the per diem rules for a psychiatric health facility day.

Who can bill H2013 and where

Only a facility that the state licenses or certifies for this level of care can bill H2013. The facility must also be enrolled with the Medicaid program or managed care plan that pays the claim.

H2013 carries no national place-of-service rule. Your state manual sets the claim form, the place-of-service or revenue code, and the facility type the payer expects. Build those settings into the H2013 charge once, so staff never choose them claim by claim.

Modifiers used with HCPCS code H2013

Modifiers tell the payer which program delivered the day. State Medicaid manuals decide which ones are required, so treat the table below as a starting point.

Attach the required modifiers to the H2013 charge template. A modifier added by hand on each claim is the one most likely to be left off.

H2013 vs. similar behavioral health codes

Several H-codes describe behavioral health programs, and they differ mainly in setting and unit. The table below compares H2013 with the codes it is most often confused with.

H2013 and H2014 sit next to each other in the code set but have little in common. H2013 is a whole facility day, while H2014 is a timed skills session. Whether a payer pays both on one date depends on whether its per diem already includes skills work.

Before you pick a code, two questions settle most cases. The first is the setting, and the second is the program and its billing unit.

Documentation requirements for H2013 claims

Every billed day needs its own record. An auditor should be able to match each unit to an admission, a current treatment plan and a note for that date.

The minimum record for each H2013 day, in line with standard billing compliance requirements, includes:

• Admission record: the admission date, the referral source, and the patient’s legal status where it applies
• Medical necessity: why the patient needs 24-hour psychiatric care, supported by a standardized measure such as LOCUS or CALOCUS where the payer accepts one
• Treatment plan: signed, current, and reviewed on the schedule your state sets
• Daily progress note: the services delivered that day, the patient’s response, and any change in risk
• Census record: confirms the patient was in the facility on each billed date, including admission and discharge days
• Authorization number: where the payer requires one, recorded on the claim and matched to the dates it covers

Leave the GAF score out of new documentation. DSM-5 dropped it in 2013, so payers now look for LOCUS, CALOCUS or another standardized functional-impairment measure.

Prior authorization and Medicaid reimbursement for H2013

Authorization rules for H2013 vary by state and by plan. Many payers approve the admission and then review the stay at set points. Managed care rules often differ from the state’s fee-for-service program, so confirm the timeline with each plan.

A typical request includes the diagnosis, a risk assessment, a LOCUS or CALOCUS score where accepted, prior treatment, and the expected length of stay. An authorization checklist completed at admission prevents the most common H2013 denial.

State Medicaid agencies set the H2013 rate. CMS publishes no national rate, because Medicare does not pay H-codes. Rates also differ between fee-for-service Medicaid and the managed care plans in the same state.

Common H2013 claim denials and how to avoid them

Most H2013 denials come from a short list of avoidable errors. Denial management strategies work best when they address each one at admission, not after the first remittance.

Billing HCPCS code H2013 correctly, step by step

A clean H2013 claim depends on each of these steps happening before the claim reaches the payer. Claims management software should enforce them at charge capture, not at remittance review.

1. Verify Medicaid eligibility for each day of the stay. Eligibility can lapse mid-stay when a renewal date passes.
2. Confirm the authorization. It must cover every billed date and still have units left. For managed care, check the plan’s own approval as well as the state’s.
3. Use the claim form and facility codes in your state manual. H2013 has no national place-of-service rule.
4. Add the required modifiers. In California, that means HE for a psychiatric health facility, plus any modifier the plan requires.
5. Enter one unit per covered day. Never convert H2013 to hourly or 15-minute units.
6. Check the record for each billed date. The daily note, current treatment plan, census entry and authorization number should all be on file.
7. Review the remittance. Watch for CARC 197 (authorization absent), CARC 50 (not medically necessary) and CARC 96 (non-covered charge).

How Pabau keeps H2013 facility days ready to defend

Psychiatric health facility billing breaks down when the authorization sits in one system, the census in another and the notes in a third. Pabau keeps those records on one patient file.

Treatment plans, daily notes and consent forms are stored against each patient with a dated audit trail. Your team can record the authorization number and its dates on the same file, so each billed day can be checked against them.

When a claim is ready, Pabau’s claims management pulls the data already on the record into the claim, then submits and tracks it. Your billing team checks dates and modifiers instead of retyping them.

Keep every H2013 facility day ready for audit

Pabau keeps authorizations, treatment plans and daily notes on one patient record, then pulls that data into each claim. Billed days match the chart.

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Conclusion

H2013 pays for a day of psychiatric health facility care, and only where the state Medicaid program recognizes that facility type. Confirm your facility holds the license the code assumes before you bill it. A partial hospitalization or day treatment program belongs on H0035 or H2012 instead.

Once the code is right, the claim rises or falls on the record. Each unit should match an authorized date, a census entry and a note showing why 24-hour care was needed. Setting modifiers and units in the charge template removes the errors that cause most rework.

Book a demo to see how Pabau keeps authorizations, notes and claims for each facility day in one place.

Continue your research

Building a billing compliance program for a small facility? Medical billing compliance maps the laws and common violations to a printable checklist built on the OIG’s seven compliance elements.

Requesting authorization for an H2013 admission? The prior authorization process lays out a five-step workflow, with a request checklist and a log sheet for open requests.

Seeing the same H2013 denial more than once? Denial management in healthcare explains how to investigate, appeal and prevent denied claims when your billing team is small.

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