H0004 and H0005: Behavioral Health Counseling Codes, Individual and Group
H0004 and H0005 are the Medicaid counseling codes. They show up where CPT psychotherapy codes either are not allowed for the program or the clinician, which is common in community and SUD programs. They also carry the unit-math errors that make H codes rule-dense.
Short answer
H0004 is "Behavioral health counseling and therapy, per 15 minutes," an individual counseling code billed in 15-minute units. H0005 is "Alcohol and/or drug services; group counseling by a clinician," whose unit the state defines. States decide which programs and credentials may use them instead of CPT psychotherapy codes. Ambetter Health has announced it will stop covering both beginning January 1, 2027.
What each code covers
| Code | Federal descriptor | Unit |
|---|---|---|
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 15 minutes |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | State-defined |
H0004 vs CPT psychotherapy
Licensed clinicians usually bill CPT psychotherapy codes such as 90834 or 90837. H0004 appears where a state routes counseling in certain programs, or by certain credentials, to an H code instead. The practical difference is the unit: a 50-minute session under H0004 is billed as 15-minute units rounded by your state's rule, not as one time-band code. Billing CPT where the program requires H0004, or the reverse, denies.
Unit math for H0004
Each unit is 15 minutes, and each state sets how many minutes count as a unit, often at least 8 minutes for one unit. Daily or weekly caps are common. Documentation should show start and stop times that support every unit billed, because unit counts are a routine audit target.
Group counseling with H0005
H0005 is group counseling for substance use by a clinician. States set group size limits, the unit, and whether each member's claim needs a group modifier such as HQ. Each attendee's note must stand on its own, with that person's participation and progress, not a copied group summary.
A 2027 payer change to watch
Ambetter Health has announced that it will stop covering a long list of H codes beginning January 1, 2027, including H0004 and H0005. That is one payer's commercial policy, posted in several states, not a national code deletion. See Ambetter's notice, and confirm with any commercial plan before assuming an H code is billable there.
Common denials
- Code does not match the program. The state requires CPT for this program, or H0004 where CPT was billed.
- Units exceed the cap. The daily or weekly maximum was exceeded.
- Time does not support units. Documented minutes do not reach the state's threshold for the units billed.
- Missing modifier. Group, program, or licensure-level modifier required by the state. See licensure and program modifiers.
The full code map is in H codes in behavioral health.
Federal HCPCS descriptors only. Your state Medicaid manual and each managed care contract define who may render the service, unit rules, caps, and rates. Verify against current guidance before billing.
Frequently asked questions
What is H0004 used for?
H0004 is behavioral health counseling and therapy billed in 15-minute units. State Medicaid programs use it for counseling in specified programs or by specified credentials, often where CPT psychotherapy codes are not used.
Is H0004 billed per session or per unit?
Per 15-minute unit. Your state sets the minimum minutes that count as a unit and any daily or weekly caps.
What is H0005?
Alcohol and/or drug group counseling by a clinician. The state defines the unit, group size limits, and any required modifiers.
Is Ambetter dropping H0004 and H0005?
Ambetter Health has announced it will stop covering both codes beginning January 1, 2027, as part of a larger list of H codes. That is one payer's policy, not a national change, so confirm with each plan you bill.
Unit math, checked on every claim.
See Stable check H-code units against documented time and your state's caps before submission.
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