HQ Modifier: Group Setting in Behavioral Health Billing
Group services are priced per person and capped by group size, so payers need to know a service happened in a group. HQ is the federal modifier for that, and states layer their own size rules on top.
Short answer
HQ is the HCPCS Level II modifier "Group setting." Ohio Medicaid lists it as the required procedure modifier for a group service. Texas requires HQ on group peer support (H0038, with HE or HF) and group certified family partner services, each capped at 12 people. Michigan replaced HQ for some services with modifiers for the number of people served, UN through US.
| Modifier | HCPCS descriptor | Type |
|---|---|---|
| HQ | Group setting | Setting |
State rules
| State program | Group rule |
|---|---|
| Ohio Medicaid | HQ is the procedure modifier for a group service |
| Texas Medicaid | Group peer support: H0038 with HE or HF, plus HQ; up to 12 people per group |
| Texas Medicaid | Group certified family partner services: S9482 with HE or HF, plus HQ; up to 12 people |
| Michigan PIHP encounters | UN (2), UP (3), UQ (4), UR (5), US (6 or more) people served, replacing TT or HQ on H2015 and T2027 |
Related setting modifiers
HR is "Family/couple with client present" and HS is "Family/couple without client present." Michigan's current code sets list HS. Use them only where the payer's code set calls for them; family psychotherapy is otherwise distinguished by the code itself.
Why group claims deny
- Group billed as individual. No HQ on a service the record shows was delivered to a group.
- Over the group cap. More participants than the state allows, such as Texas's 12.
- Old modifier. HQ sent to Michigan for a service that now needs a UN to US group-size modifier.
- Missing companion modifier. Texas group peer support needs HE or HF as well as HQ.
Related: H0038 peer support, all behavioral health HCPCS modifiers, and the code map in H codes in behavioral health.
Sources, read October 2026: Ohio Medicaid Behavioral Health Provider Manual, v1.28.1 (March 2026); Texas Medicaid Behavioral Health and Case Management Services Handbook (January 2026); MDHHS SFY 2027 Behavioral Health Code Charts and Provider Qualifications. Federal HCPCS descriptors are CMS public data. State manuals and plan contracts change; confirm the current edition before billing.
Frequently asked questions
What is the HQ modifier?
HQ is the HCPCS Level II modifier "Group setting." It identifies a service delivered in a group.
What is the group size limit for Texas Medicaid peer support?
Texas limits group peer support to 12 people per group session, billed as H0038 with HE or HF plus HQ.
Does Michigan still use HQ?
For some services Michigan replaced TT or HQ with group-size modifiers: UN for two people up to US for six or more.
Group services, billed with the right rules.
See Stable check group modifiers and size caps against each state's rules before claims go out.
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