MedicaidBilling CodesMedium impact
Changes to daily limits for fee-for-service SUD treatment codes, effective January 1, 2019
Oregon Health Plan·OR · Psychiatry·Provider
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Oregon Health Authority has implemented daily limits for substance use disorder treatment codes effective January 1, 2019. H0005 and H0006 are limited to 2 services per day, while H0015 is limited to 1 service per day. Providers must use specific modifiers (HF for substance use disorder, HG for opioid use disorder) when billing these codes.
Action Required
Immediately: Billing team must update system to enforce daily limits for SUD codes - H0005 and H0006 limited to 2 per day, H0015 limited to 1 per day. Add required modifiers HF (substance use disorder) and HG (opioid use disorder) to billing software. Update encounter forms to remind providers of daily limits. Claims exceeding limits will be denied.