`H2036` A/d tx program, per diem

Alcohol and/or other drug treatment program, per diem

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

Medicare pricing for H2036

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for H2036

41 of 43 payer prior-auth lists that name H2036 require prior authorization or set conditions: Aetna, Blue Cross and Blue Shield of Illinois, 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, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky), Rocky Mountain Health Plans.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Aetna	Medicare Advantage	All	prior auth required		Aug 1, 2024	Participating provider behavioral health precertification list for Aetna
Aetna	Commercial	All	prior auth required		Aug 1, 2024	Participating provider behavioral health precertification list for Aetna
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Oct 1, 2026	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jan 1, 2025	Procedure Code List, Effective 1/1/2025
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	IL	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
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
Humana	Humana Healthy Horizons	OH	prior auth required		Jan 1, 2027	555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
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	PA required for stay greater than 30 days, up to 30 consecutive days without PA, PA must…; pa required for stay greater than 30 days, up…	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, 2020	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Texas	Exchange	TX	prior auth required		Jul 1, 2020	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required		Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Rocky Mountain Health Plans	Northeast Health Partners RAE 2 behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Northeast Health Partners RAE 2 Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care professionals
Rocky Mountain Health Plans	Northeast Health Partners RAE 2 behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Northeast Health Partners RAE 2 Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care professionals
Rocky Mountain Health Plans	Northeast Health Partners RAE 2 behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Northeast Health Partners RAE 2 Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care professionals
Rocky Mountain Health Plans	Northeast Health Partners RAE 2 behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Northeast Health Partners RAE 2 Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care professionals
Rocky Mountain Health Plans	Rocky Mountain D-SNP behavioral health	CO	prior auth required		Jul 1, 2025	Behavioral health prior authorization requirements for Rocky Mountain Medicare Advantage and Dual Special Needs Plans Effective July 1, 2025 This guide provides an overview of the CPT® and HCPCS codes
Rocky Mountain Health Plans	Rocky Mountain D-SNP behavioral health	CO	prior auth required		Jul 1, 2025	Behavioral health prior authorization requirements for Rocky Mountain Medicare Advantage and Dual Special Needs Plans Effective July 1, 2025 This guide provides an overview of the CPT® and HCPCS codes
Rocky Mountain Health Plans	Rocky Mountain D-SNP behavioral health	CO	prior auth required		Jul 1, 2025	Behavioral health prior authorization requirements for Rocky Mountain Medicare Advantage and Dual Special Needs Plans Effective July 1, 2025 This guide provides an overview of the CPT® and HCPCS codes
Rocky Mountain Health Plans	Rocky Mountain D-SNP behavioral health	CO	prior auth required		Jul 1, 2025	Behavioral health prior authorization requirements for Rocky Mountain Medicare Advantage and Dual Special Needs Plans Effective July 1, 2025 This guide provides an overview of the CPT® and HCPCS codes
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+ behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+ Effective July 1, 2026 This list reviews the prior authorization requirements for which Rocky Mountain Health Pl
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+ behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+ Effective July 1, 2026 This list reviews the prior authorization requirements for which Rocky Mountain Health Pl
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+ behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+ Effective July 1, 2026 This list reviews the prior authorization requirements for which Rocky Mountain Health Pl
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+ behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans CHP+ Effective July 1, 2026 This list reviews the prior authorization requirements for which Rocky Mountain Health Pl
Rocky Mountain Health Plans	Rocky Mountain Health Plans RAE/Prime behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans RAE/PRIME Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care profess
Rocky Mountain Health Plans	Rocky Mountain Health Plans RAE/Prime behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans RAE/PRIME Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care profess
Rocky Mountain Health Plans	Rocky Mountain Health Plans RAE/Prime behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans RAE/PRIME Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care profess
Rocky Mountain Health Plans	Rocky Mountain Health Plans RAE/Prime behavioral health	CO	prior auth required		Jul 1, 2026	Behavioral health prior authorization requirements for Rocky Mountain Health Plans RAE/PRIME Medicaid Effective July 1, 2026 This list contains prior authorization requirements for health care profess

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2025: PA added, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in IN, MD, OH.

KY: $408.24 (behavioral_health), effective Jul 15, 2026
ND: $637.20 (behavioral_health), effective Jul 1, 2026
WA: $14.20 (substance_use_disorder), effective Jul 1, 2026

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.

H2036 A/d tx program, per diem