HCPCS Level II › H codes H0012 Alcohol and/or drug servicesAlcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient)
Medicare coverage: Not payable by Medicare Status: active (October 2026 file) Medicare pricing for H0012 Physician Fee Schedule (CY 2026, RVU26D) Status I: not valid for Medicare (Medicare uses another code).
Payer policies and prior authorization for H0012 22 of 27 payer prior-auth lists that name H0012 require prior authorization or set conditions: Blue Shield of California, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Blue Shield of California Blue Shield Medicare CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield Medicare Blue Shield of California Blue Shield commercial CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield Humana Humana Healthy Horizons OH prior auth under conditions Beyond limit: after 7 consecutive units Jan 1, 2027 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list Molina Complete Care (Virginia) Medicaid VA prior auth required Apr 1, 2025 Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 Molina Healthcare of California Medicaid CA prior auth required Apr 1, 2026 Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 Molina Healthcare of Idaho Medicaid ID prior auth required Jan 1, 2025 Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 Molina Healthcare of Illinois Medicaid IL prior auth required Jan 1, 2022 Molina Healthcare of Illinois Codification Grid Q3 2026 Molina Healthcare of Iowa Medicaid IA prior auth required Jul 1, 2023 IA Prior Authorization Matrix, effective Q3 2023 Molina Healthcare of Michigan Exchange MI prior auth required Jul 1, 2021 Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 Molina Healthcare of Mississippi Medicaid MS prior auth required Jan 1, 2025 Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 Molina Healthcare of Nevada Medicaid NV prior auth required Oct 1, 2022 Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 Molina Healthcare of New Mexico Medicaid NM prior auth required Jul 1, 2026 New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 Molina Healthcare of Ohio Exchange OH prior auth required Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Ohio Exchange OH prior auth required *Requires PA with IHBT Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Texas STAR TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 Molina Healthcare of Texas STAR+PLUS TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 Molina Healthcare of Texas STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) TX prior auth required Jul 1, 2026 Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 Molina Healthcare of Texas Exchange TX prior auth required Sep 1, 2019 Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 UnitedHealthcare Community Plan Texas CHIP TX prior auth required Apr 1, 2026 Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care UnitedHealthcare Community Plan Texas STAR TX prior auth required Apr 1, 2026 Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h UnitedHealthcare Community Plan Texas STAR Kids TX prior auth required Apr 1, 2026 Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki UnitedHealthcare Community Plan Texas STAR+PLUS TX prior auth required Apr 1, 2026 Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
Recent prior-auth changes Jul 1, 2026: PA removed, Humana Jul 1, 2026: PA added, Humana Jul 1, 2026: PA added, Humana Apr 1, 2026: PA added, UnitedHealthcare Community Plan Apr 1, 2026: PA added, UnitedHealthcare Community Plan Apr 1, 2026: PA added, UnitedHealthcare Community Plan Apr 1, 2026: PA added, UnitedHealthcare Community Plan Jul 1, 2025: PA removed, Passport by Molina Healthcare (Kentucky) Medicaid fee-for-service Prior authorization required or conditional in IN, OH.
ND: $199.90 (behavioral_health), effective Jul 1, 2026 TX: $88.95 (outpatient_behavioral_health_chemical_dependencytreatment_fa, Outpatient Behavioral Health - Chemical Dependencytreatment Facility, facility), effective Mar 1, 2022 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.