HCPCS Code H0019: Behavioral Health, Long-Term Residential

## **What is behavioral health, long-term residential treatment?** Behavioral health long-term residential care is a structured treatment program designed for individuals who require extended support in managing behavioral health conditions. Unlike acute hospital settings, this service provides non-acute care and term residential non-medical support, focusing on rehabilitation, skill-building, and recovery. A long-term residential setting often operates without room and board, meaning lodging and meals may be billed separately, sometimes as room and board per diem. This type of care is a treatment program where the stay is longer than short-term rehabilitation, and the stay is typically longer to allow for consistent monitoring, therapy, and support. While it is considered medical non-acute care or non-medical in nature, the program can integrate drug services, counseling, and behavioral therapies. This approach aligns with some Medicaid services coverage criteria for individuals needing care in a residential environment for stabilization and recovery.

## **H0019 documentation requirements** Providers must ensure documentation reflects the extended nature and non-medical scope of care. Here are some items to check off: - Clearly identify that the service provided is behavioral health, long-term residential treatment, and that it is non-acute care in a long-term residential health setting. - Indicate that room and board per diem is billed separately and not included in the service. - Document presenting symptoms, diagnoses, or behaviors that justify placement in a treatment program requiring a stay that is typically longer than 30 days. - Record the treatment program structure, scheduled interventions, and therapeutic focus delivered during the stay. - Include baseline assessments, individualized care plans, and measurable treatment objectives established at admission. - Provide ongoing progress notes with updates on status, response to treatment, and any changes in interventions. - Specify the involvement of therapists or other care providers and their roles in delivering the program. - Outline discharge criteria and plans for aftercare or transition following the residential stay.

## **H0019 billing requirements** H0019 is used for billing behavioral health long-term residential services in a non-acute care setting, covering treatment but excluding room and board per diem charges. - Service must be delivered in a behavioral health long-term residential setting that provides non-acute care. - The code covers the treatment program only; room and board per diem is billed separately. - Stay is typically longer than short-term stabilization programs and may involve non-medical residential services. - Billing should reflect the daily rate for covered program services and comply with payer-specific rules for service units. - Providers must ensure that documentation supports medical necessity and aligns with coverage criteria for Medicaid services or other payers. - Bill only for days when program services are delivered; days without service delivery are not billable.

## **Other relevant codes** - H0012: Behavioral health long-term residential services, with room and board per diem, non-medical. - H0013: Behavioral health long-term residential treatment program, non-acute care, stay is typically longer for recovery support. - H0018: Behavioral health short-term residential treatment program where stay is shorter, excludes room and board per diem.

Frequently asked questions

H0019 is used for behavioral health long-term residential treatment services where the stay is typically longer and supports ongoing recovery. It differs from short-term codes by focusing on extended non-acute care in a treatment program.

No. H0019 is billed without room and board, and is specifically for the treatment program portion of long-term health residential services. Room and board costs are billed separately if applicable.

H0019 is intended for non-medical and medical non-acute care within a treatment program. It can also apply to certain drug services when part of a structured long-term recovery plan.