H0035 — Partial hospitalization

A day of partial hospitalization — the level of care between residential and intensive outpatient: several hours of structured programming a day, most days of the week, without an overnight stay. It is the program's own facility line, distinct from the professional work delivered inside the program day, which bills separately. Because H0035 functions in practice as a level-of-care line, one PHP program's day and another's are the same billing event regardless of what the program treats — the diagnosis lives in the claim's ICD coding, not in the code or the rate. That is the mechanism behind “there is no eating-disorder billing code,” and in practice it applies to PHP exactly as it does to residential.

Facility. H0035 pays the program for the day, not a clinician for a visit; group, individual, and psychiatric services delivered within the program bill separately on the professional side. The H0035 conversation with a payer is therefore a per-diem or program-rate negotiation — hours of programming, staffing, clinical intensity — and the number that matters is the negotiated day rate a payer publishes for the facility in its Transparency in Coverage file.

Revenue codes 0912 and 0913 — the partial-hospitalization accommodation lines on a facility claim (0912 for less-intensive, 0913 for intensive partial hospitalization). A PHP day typically goes out with one of those revenue codes and H0035 as the HCPCS line. Some payers require the revenue code and the HCPCS code together for the claim to price; others key the program rate on one or the other, and a contract may define the day rate against the revenue code alone. Read a rate file accordingly: an “H0035 rate” and a “0913 rate” may be one contract line or two.

Because the code is the only thing two programs share. PHP day rates vary with the contracting entity (a national behavioral health network, a commercial carrier's own book, a regional plan), the market, when the rate was last negotiated, and the structure — a per-diem day rate, a case rate for the episode, or a percent of charges — as well as with how the contract defines a program day (hours, days per week). And as with residential, a public Medicaid schedule price for a PHP code is a state-set floor, not the market.

By placing it inside the distribution of comparable facilities' negotiated H0035 rates in its market, with the same payer, and reading the result as a percentile position — never a blended average. PHP is where a shared code matters as much as it does for residential: the comparison set is every partial hospitalization program a payer pays in the market, not only those treating the same condition. Ratebench and Peerbench do this on actual negotiated rates resolved to the facility and scored for confidence, with the Massachusetts and North Carolina Medicaid schedules beneath the distribution as a reference floor. The fastest way to see where your PHP rate stands is a free rate analysis of your own contract.