`H2013` Psych hlth fac svc, per diem

Psychiatric health facility service, per diem

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for H2013

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for H2013

14 of 17 payer prior-auth lists that name H2013 require prior authorization or set conditions: Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, 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.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	LA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate
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 Iowa	Medicaid	IA	prior auth under conditions	PA after 3 days	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 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

Payer coverage policies that name H2013

H2013 appears in 1 coverage policy from Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

Payer	Policy	Role in policy	Reviewed	Document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Medical Policies Moving to MCG Guidelines Autism Spectrum Disorder \| 97157, 97158, G8539, G9012, \| (BHG)	listed, no stance	Jan 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2026: PA removed, Passport by Molina Healthcare (Kentucky)
Jan 1, 2026: PA removed, Molina Healthcare of Michigan
Oct 1, 2025: PA added, Passport by Molina Healthcare (Kentucky)
Jul 1, 2025: PA removed, Passport by Molina Healthcare (Kentucky)
Jan 1, 2024: PA removed, Molina Healthcare of Michigan

Medicaid fee-for-service

Prior authorization required or conditional in VA.

LA: $496.95 (specialized_behavioral_health, Rate), effective Jan 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
WY: $0.00 (professional), effective Jul 1, 2016

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.

H2013 Psych hlth fac svc, per diem