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August 2026 Top of Mind
Important code changes for SUD outpatient Medicaid services for Medica members
Hot off the presses this summer: The Minnesota Department of Human Services (DHS) has changed the code requirements for substance use disorder (SUD) outpatient services. If you’re an Optum-contracted provider who delivers services to Medicaid members covered by a Medica health plan, please review for more details.
Billing code changes
Effective Aug. 1, 2026, providers can no longer bill using procedure code H2035 for individual or group SUD outpatient services. Instead, for services provided on or after August 1, you should bill using the new 15-minute codes as outlined in the July 13, 2026 DHS 2026 Guide to Substance Use Disorder Service Changes.
SUD Treatment Services |
Outpatient Procedure Codes |
|---|---|
Individual counseling |
H0004 with modifier U8 |
Group counseling |
H0005 with modifier U8 |
Individual psychoeducation |
H2027 with modifier U8 |
Group psychoeducation |
H2027 with modifiers U8 HQ |
Individual recovery support |
H2017 with modifier U8 |
Group recovery support |
H2017 with modifiers U8 HQ |
Treatment coordination (no change) |
T1016 with modifiers HN U8 |
Peer recovery support (no change) |
H0038 with modifier U8 |
Claim submissions
To ensure claims can be processed accurately and quickly, please note:
- Facilities: If your current contract for H2035 is on a facility agremeent with revenue codes 944, 945 and 953, you should continue to submit claims with revenue codes for H0004, H0005 and H2027. All other codes should be billed without revenue codes.
- Individual Clinicians/Groups: Please submit claims via an 837P EDI submission.
Contract and fee schedule updates
Your Optum Participation Agreement and/or fee schedule is being updated to reflect the move to 15-minute codes. You can request an updated copy by calling Provider Services at 1-877-614-0484, Monday – Friday, 7 a.m. – 7 p.m. CT.
Why the changes were made
The Minnesota Department of Human Services made these changes as part of their dedicated efforts to more effectively provide whole person care for those with substance use disorders at the right level, in the right amount, at the right time. Additional information can be found in these resources:
Questions? We’re here to help.
For more information, please call Provider Services at 1-877-614-0484, Monday – Friday, 7 a.m. – 7 p.m. CT.
