HCPCS Code H0038: Self-Help/Peer Services, Per 15 Minutes

Properly use and bill HCPCS code H0038. Check out our comprehensive guide, which includes a list of documentation requirements and billing guidelines.

Use Code

What is HCPCS code H0038?

HCPCS code H0038, a level II code, is used by mental health providers to bill for "self-help/peer services, per 15 minutes". It refers to peer support services, provided by trained individuals who have lived experience and personal experience with mental health conditions or substance use disorder.

The service activities billed under this code include teaching practical coping mechanisms, helping individuals navigate community resources, and providing support during challenging times/potential relapses to reduce isolation.

Though non-clinical and not a replacement for traditional clinical interventions, they aim to promote recovery, community integration, and self-efficacy. Furthermore, the offered services can be part of a recovery-oriented approach.

HCPCS code H0038 documentation requirements

For proper documentation of HCPCS code H0038, the patient's medical codes must include the following:

Details of the services provided
A treatment plan or service plan
Progress notes that reflect progress toward the patient's recovery goals
Proof of medical necessity
Staff credentials confirming completion of required training or certification
Time-specific records, noting 15-minute increments of direct service delivery

H0038 billing requirements

H0038 is billed in 15-minute units and must:

Be delivered by certified peer specialists meeting state training criteria.
Be tied to a formalized recovery plan that is reviewed regularly.
Must be submitted using the appropriate claim form
Some states also require the use of the place of service and population-specific modifiers.