H0031 HCPCS Code: Mental Health Assessment Guide

The H0031 HCPCS code reports a mental health assessment performed by a non-physician — a clinical interview, diagnostic formulation, risk assessment, and treatment recommendations delivered by a licensed clinician who is not a physician. It is a Medicaid-oriented behavioral-health code, so the rules that govern it come from state Medicaid programs rather than the CPT manual, and which payer accepts it is the first thing to confirm.

What is the H0031 HCPCS code? H0031 is the Healthcare Common Procedure Coding System (Level II) code for a mental health assessment performed by a non-physician clinician, used primarily by state Medicaid programs to report behavioral-health assessments.

Undeny's Take

H0031 lives in the part of behavioral-health billing where the code is right but the payer determines everything. It is a Medicaid construct: many state Medicaid programs use H0031 for a non-physician mental health assessment, while commercial payers generally expect the CPT diagnostic evaluation codes (90791, or 90792 when a medical component requires a physician) instead. Send H0031 to a commercial plan and it often bounces; send 90791 to a Medicaid program that wants H0031 and it can bounce the other way. The discipline is payer-specific: know which assessment code each plan accepts, who is licensed to render it under that state's rules, and the unit or time conventions the program imposes. Map the code to the payer before you submit, and H0031 stops being a denial generator.

What H0031 Covers

H0031 covers a behavioral-health assessment by a non-physician: a clinical interview, mental status evaluation, risk assessment, diagnostic formulation, and recommendations for treatment, sometimes with collateral input from caregivers. It is the non-physician assessment used in many state Medicaid and community-mental-health settings, distinct from the physician-performed evaluation and from ongoing psychotherapy.

Who Can Report It and How

H0031 is reported by appropriately licensed non-physician clinicians — for example licensed counselors, clinical social workers, or marriage and family therapists — as permitted under state law and the Medicaid program's rules. Some programs apply a 15-minute unit convention or other time and documentation requirements, which vary by state. Reimbursement is set at the state Medicaid level rather than a national fee schedule, so confirm the program's rate and rules or use the CPT estimator as a starting point.

H0031 Versus the CPT Evaluation Codes

90791 — psychiatric diagnostic evaluation without medical services; the common commercial equivalent.
90792 — diagnostic evaluation with medical services, performed by a physician or qualified prescriber.
Commercial payers generally prefer the CPT codes; many Medicaid programs use H0031 for the non-physician assessment.
Match the assessment code to the specific payer's accepted code set before billing.

Common H0031 Denials

Billed to a commercial payer that expects CPT 90791 or 90792 instead.
Rendered by a provider type the state program does not authorize for the code.
Units or time billed inconsistent with the Medicaid program's convention.
Missing documentation elements the program requires to support the assessment.

Related Codes

H0031 parallels the CPT diagnostic evaluations 90791 (without medical services) and 90792 (with medical services). Browse the full set under CPT codes.

Frequently Asked Questions

What does H0031 cover?

H0031 covers a mental health assessment by a non-physician — a clinical interview, mental status and risk assessment, diagnostic formulation, and treatment recommendations. It is used mainly by state Medicaid programs.

What is the difference between H0031 and 90791?

H0031 is a HCPCS code many Medicaid programs use for a non-physician assessment, while 90791 is the CPT psychiatric diagnostic evaluation most commercial payers accept. The choice depends on the payer's accepted code set.

Who can bill H0031?

Appropriately licensed non-physician clinicians — such as licensed counselors, clinical social workers, or marriage and family therapists — as permitted under state law and the Medicaid program's rules. Authorized provider types vary by state.

Does Medicare pay H0031?

Generally no. H0031 is primarily a Medicaid and community-behavioral-health code; Medicare and commercial payers typically use the CPT evaluation codes instead. Confirm the specific payer's accepted codes before billing.

Informational only — not legal, medical, or billing advice. Always verify against your state Medicaid program and payer policy.

Estimate H0031 reimbursement

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