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Required Use of HQ Modifier for Group Services
Oct 14, 2025, 18:50 PM
CareOregon is making an important update regarding billing practices for group behavioral health services effective January 1, 2026.
Definition of HQ Modifier
The HQ modifier is used to indicate that a service was provided in a group setting. When appended to a procedure code, it communicates to payers that the service was delivered to multiple clients simultaneously, rather than on an individual basis.
New Requirement
Effective January 1, 2026, all claims submitted for group behavioral health services must include the HQ modifier. This requirement applies to all applicable procedure codes where services are delivered in a group format, and the code does not already have “group” in the description.
Action Required
- Review your billing procedures and ensure that the HQ modifier is correctly applied to all group service claims.
- Update your electronic health record (EHR) systems and billing software as needed.
- Train relevant staff on the proper use of the HQ modifier to ensure compliance.
Failure to include the HQ modifier on group service claims may result in denied or delayed reimbursement.
Thank you for your attention to this update and for your continued commitment to providing high-quality behavioral health services.
Download this update and codes as a PDF
Behavioral Health Codes and use of Modifier HQ
Please note that the following list is not exhaustive and reflects information available as of the date of this letter. For complete descriptions of the codes and the most current information regarding the appropriate use of these codes listed below, please refer to the official CPT and HCPCS handbooks.
| Code | Description | HQ Modifier Use |
| Code | Description | HQ Modifier Use |
|---|---|---|
| 90785 | Interactive complexity code | Service ineligible to be performed in a group setting |
| 90791-90792 | Psychiatric diagnostic evaluation | Service ineligible to be performed in a group setting |
| 90832-90840 | Psychotherapy | Service ineligible to be performed in a group setting |
| 90846-90847 | Family Psychotherapy | Service ineligible to be performed in a group setting |
| 90849 | Multiple-family group psychotherapy | HQ not required, Group is in the description |
| 90853 | Group psychotherapy | HQ not required, Group is in the description |
| 90867-90869 | Transcranial magnetic stimulation treatment | Service ineligible to be performed in a group setting |
| 90882 | Environmental intervention for medical management | Service ineligible to be performed in a group setting |
| 90887 | Consultation with family | Service ineligible to be performed in a group setting |
| 90899 | Unlisted Service and Procedure Extended Outreach Support | Service ineligible to be performed in a group setting |
| 96130-96131 | Psychological testing evaluation services | Service ineligible to be performed in a group setting |
| 96136-96167 | Psychological or neuropsychological test | Service ineligible to be performed in a group setting |
| 96202-96203 | Multiple-family group psychotherapy | HQ not required, Group is in the description |
| 97151-97153, 97155 | Behavior identification assessment/treatment | Service ineligible to be performed in a group setting |
| 97154 | Group behavior treatment by protocol administered by technician, each 15 minutes, per recipient | HQ not required, Group is in the description |
| 97156 | Family behavior treatment guidance administered by qualified health care professional, each 15 minutes, single family | Service ineligible to be performed in a group setting |
| 97157 | Family behavior treatment guidance administered by qualified health care professional, 15 minutes, per family | HQ not required, Group is in the description |
| 97158 | ABA - Group adaptive behavior treatment with protocol modification administered by physician or other QHP | HQ not required, Group is in the description |
| 97810-97814 | Acupuncture | Service ineligible to be performed in a group setting |
| 98966-98968 | Telephone assessment and management service provided by a qualified nonphysician health care professional | Service ineligible to be performed in a group setting |
| 99202-99215 | Office or other outpatient visit for the evaluation and management | Service ineligible to be performed in a group setting |
| 99341-99350 | Home visit for the evaluation and management | Service ineligible to be performed in a group setting |
| 99354-99359, 99415-99417 | Prolonged service(s) | Service ineligible to be performed in a group setting |
| 99366-99368 | Medical team conference | Service ineligible to be performed in a group setting |
| 99407 | Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes | Service ineligible to be performed in a group setting |
| 99421-99423 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes | Service ineligible to be performed in a group setting |
| 0362T | ABA - Behavior identification supporting assessment administered by physician or other QHP with the assistance of two or more technicians | Service ineligible to be performed in a group setting |
| 0373T | ABA - Adaptive behavior treatment with protocol modification administered by physician or QHP with the assistance of two or more technicians | Service ineligible to be performed in a group setting |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | HQ modifier is required when performed in a group setting |
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | HQ modifier is required when performed in a group setting |
| G2012 | Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified healthcare professional who can report on evaluation and management services. | Service ineligible to be performed in a group setting |
| G2025 | Telehealth distant site service furnished by a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) only | Service ineligible to be performed in a group setting |
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled opioid treatment program) | HQ modifier is required when performed in a group setting |
| G2068 | Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2069 | Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2070 | Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2071 | Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2072 | Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2073 | Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed | HQ modifier is required when performed in a group setting |
| G2076 | Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized health care professional under the supervision of a program physician qualified personnel | Service ineligible to be performed in a group setting |
| G2077 | Periodic assessment | Service ineligible to be performed in a group setting |
| G2078 | Take home supply of methadone | Service ineligible to be performed in a group setting |
| G2079 | Take home supply of buprenorphine (oral) | Service ineligible to be performed in a group setting |
| G2080 | Each additional 30 minutes of counseling in a week of medication assisted treatment; list separately | HQ modifier is required when performed in a group setting |
| G2086 | Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month | HQ modifier is required when performed in a group setting |
| G2087 | Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month | HQ modifier is required when performed in a group setting |
| G2088 | Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes; list separately | HQ modifier is required when performed in a group setting |
| G2215 | Take home supply of nasal naloxone | Service ineligible to be performed in a group setting |
| G9012 | Substance Use Care Coordination; services provided to transition an individual from higher levels of care (inpatient or residential) to lower levels of care. | Service ineligible to be performed in a group setting |
| H0001 | Alcohol and/or Drug Assessment | Service ineligible to be performed in a group setting |
| H0002 | Behavioral Health screening to determine eligibility for admission to treatment program(s) | Service ineligible to be performed in a group setting |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | HQ modifier is required when performed in a group setting |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | HQ not required, Group is in the description |
| H0006 | Alcohol and/or drug services; Case Management | Service ineligible to be performed in a group setting |
| H0010 | Alcohol/Drug services; sub-acute, medically monitored detoxification. (as an alternative to inpatient ASAM Level III.7-D) | Service ineligible to be performed in a group setting |
| H0011 | Alcohol/Drug services; acute, medically monitored detoxification. (as an alternative to inpatient ASAM Level III.7-D) | Service ineligible to be performed in a group setting |
| H0012 | Alcohol/Drug services; sub-acute, clinically managed detoxification. (outpatient ASAM Level III.2-D) | Service ineligible to be performed in a group setting |
| H0013 | Alcohol/Drug services; acute (H0013), clinically managed detoxification. (outpatient ASAM Level III.2-D) | Service ineligible to be performed in a group setting |
| H0014 | Ambulatory detoxification service for mild to moderate withdrawal from substance abuse (Ambulatory ASAM Level II-D). | Service ineligible to be performed in a group setting |
| H0015 | Alcohol and/or drug services; Intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan). | Service ineligible to be performed in a group setting |
| H0016 | Alcohol and/or drug services; Medical/somatic intervention in ambulatory setting | Service ineligible to be performed in a group setting |
| H0018 | Alcohol and/or drug services, Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem | Service ineligible to be performed in a group setting |
| H0019 | Alcohol and/or drug services, Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | Service ineligible to be performed in a group setting |
| H0020 | Alcohol and/or drug services; Methadone administration and/or services (provision of the drug by licensed program) | Service ineligible to be performed in a group setting |
| H0022 | Alcohol and/or drug intervention service (planned facilitation) | HQ modifier is required when performed in a group setting |
| H0023 | Intensive In-Home Behavioral Health Treatment Services (IIBHT) | Service ineligible to be performed in a group setting |
| H0031 | Mental health assessment, by non-physician. | Service ineligible to be performed in a group setting |
| H0032 | Mental health service plan development by non-physician. | Service ineligible to be performed in a group setting |
| H0033 | Oral Medication Administration, direct observation. | Service ineligible to be performed in a group setting |
| H0034 | Medication training and support, per 15 minutes. | Service ineligible to be performed in a group setting |
| H0035 | Partial Hospitalization | Service ineligible to be performed in a group setting |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes. | HQ modifier is required when performed in a group setting |
| H0037 | Community psychiatric supportive treatment program, per diem | Service ineligible to be performed in a group setting |
| H0038 | Self-help/peer services | HQ modifier is required when performed in a group setting |
| H0039 | Assertive community treatment, face-to-face, per 15 minutes. | Service ineligible to be performed in a group setting |
| H0045 | Respite care services, not in the home, per diem | Service ineligible to be performed in a group setting |
| H0048 | Alcohol and/or drug testing; Collection and handling only, specimens other than blood | Service ineligible to be performed in a group setting |
| H0050 | Alcohol and/or drug services, brief intervention, per 15 minutes | HQ modifier is required when performed in a group setting |
| H2000 | Child and Adolescent Needs Survey (CANS) | Service ineligible to be performed in a group setting |
| H2010 | Comprehensive Medication Services | Service ineligible to be performed in a group setting |
| H2011 | Crisis intervention service, per 15 minutes | Service ineligible to be performed in a group setting |
| H2012 | Behavioral health day treatment, per hour | Service ineligible to be performed in a group setting |
| H2013 | Psychiatric health facility service, per diem | Service ineligible to be performed in a group setting |
| H2014 | Skills training and development, per 15 min | HQ modifier is required when performed in a group setting |
| H2021 | Community based wraparound services | Service ineligible to be performed in a group setting |
| H2023 | Supported employment | HQ modifier is required when performed in a group setting |
| H2027 | Psychoeducational Services | HQ modifier is required when performed in a group setting |
| H2032 | Activity therapy, per 15 min | HQ modifier is required when performed in a group setting |
| Q3014 | Telehealth originating site facility fee | Service ineligible to be performed in a group setting |
| S9453 | Smoking cessation classes, non-physician provider | HQ not required, Group is in the description |
| S9480 | Intensive Outpatient | Service ineligible to be performed in a group setting |
| T1005 | Respite Care Services | Service ineligible to be performed in a group setting |
| T1006 | Alcohol and/or substance abuse services; Family/couple counseling | Service ineligible to be performed in a group setting |
| T1007 | Alcohol and/or substance abuse services, treatment plan development and/or modification | Service ineligible to be performed in a group setting |
| T1016 | Case Management | Service ineligible to be performed in a group setting |
| T1023 | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter | Service ineligible to be performed in a group setting |
| T1502 | Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional | Service ineligible to be performed in a group setting |
