Provider updates

Oct 10, 2025, 22:57 PM

CareOregon is making an important change regarding billing practices for behavioral health services, including those provided in a group setting.

Effective January 1, 2026, CareOregon will limit billing for code H0004 to eight hours per provider per day. If CareOregon receives claims for more than a cumulative eight hours using billing code H0004 (excluding group services) for a single provider on a single day, all services will be denied. Claims can be reconsidered based on the receipt of medical records that support billing for more than eight hours. If the claim is for group services, use the HQ modifier to bypass the eight (8) hours limit.

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.

Please see the Behavioral Health Codes and use of Modifier HQ list for a complete list of codes and acceptable use.

If you have questions or need assistance with implementation, please contact Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.

Thank you for your attention to this update and for your continued commitment to providing high-quality behavioral health services.