Aug. 1 updates to Substance Use Disorder (SUD) billing and extension guidelines

09/15/2026

Hennepin Health follows DHS guidance on billing requirements for Residential and Outpatient Substance Use Disorder (SUD) services.
Enhanced rate options can be applied when a provider has been approved for the enhancement and meets DHS requirements.

SUD programs licensed by the state are required to submit claims on Claim format 837I/Type of Bill 89x or 13x.
Other eligible SUD providers will submit claims on Claim format 837P.

New SUD treatment services are billed in 15-minute unit increments. Reference the DHS SUD Service Rate Grid for details.

Modifier billing rules for new SUD Outpatient codes

Bill U8 modifier in first position.
H2017 and H2027 codes are also used for mental health services.
- If U8 is not billed, pricing will default to the mental health fee schedule.
Codes H2027 U8 and H2017 U8 require HQ modifier when billing for services provided in a group setting.
- Bill HQ modifier after U8.
H0004 is an individual treatment code, do not bill with HQ modifier.
H0005 is a group therapy code, it does not require HQ modifier.
Enhanced payment rate modifiers HH, U5, U3, U4, U5, U6, and/or UC, should be billed after U8 or U8 HQ modifiers.
Modifiers GT, GY, HA, PO, 93, or 95, should be billed after the enhanced payment rate modifiers. Services delivered via telehealth only require one telehealth modifier.

Do not bill U5 or HH modifier with UC modifier. UC modifier is a combination of HH and U5 modifier rate.

Do not bill HN modifier with outpatient SUD codes.

Extension requirements for SUD treatment

Initial placements for SUD require no prior authorization.

Notification of member placement is required within 10 business days of service initiation. Please complete the Client SUD treatment notification and Extension request form (PDF, 1MB).

Utilization review required at the following intervals:

Inpatient hospital-based stays: extension required after 18 days
- Revenue code 0101
Residential placement: extension required after 60 days
- HCPCS code H2036
Outpatient Individual SUD treatment: extension required after 120 units
- HCPCS codes H0004 U8, H2017 U8, H2027 U8
Outpatient Group SUD treatment: extension required after 1200 units
- HCPCS codes H0005 U8, H2027 U8 HQ, H2017 U8 HQ

Submit extension requests no later than 10 business days prior to the exhaustion of initial or previously approved units. The Client SUD treatment notification and Extension request form (PDF, 1MB) must be used for this purpose. The form must include the client’s SUD diagnosis and ASAM risk ratings that support the level of care being requested.

Send discharge summary or discharge notification within 10 business days of member discharge.

Send forms to the Hennepin County Addiction and Recovery Services unit at 612-466-9546 (fax) or email HC.ReviewTeam@hennepin.us. Call Hennepin County Addiction and Recovery Services with questions at 612-879-3671.

Failure to submit required notification and/or extension form may result in lack of or delay in payment.

Hennepin Health daily limits

Any combination of these procedure codes will be limited to six hours (24 units) per day:
- Individual Counseling, H0004 U8
- Group Counseling, H0005 U8
- Individual Psychoeducation, H2027 U8
- Group Psychoeducation, H2027 U8 HQ
Recovery support services (procedure code H2017 U8 and H2017 U8 HQ) will have a maximum of 16 units (4 hours) per client per day for combined individual and group services

If a provider performs two or more of the same service for a client in a day, the billable unit for the day is based on the total combined minutes of service provided. When determining the total, count only the actual number of minutes of service provided, not including breaks.

Overlapping claim submission times are duplicative and ineligible for payment. Once a unit of time has been “claimed,” another service cannot be provided and claimed during the same time period.