Historical trauma (ht) mental health and clinical care for indigenous persons
Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (clinical), rationale: Nature of Service/Procedure
Outpatient hospital: max 1 units per day (clinical), rationale: Nature of Service/Procedure
Medicare pricing for H0053
Physician Fee Schedule (CY 2026, RVU26D)
Status I: not valid for Medicare (Medicare uses another code).
Payer policies and prior authorization for H0053
Medicaid fee-for-service
Prior authorization required or conditional in IN.
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Jan 1, 2025
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.