H0023 — Prioritized List diagnosis reference
Oregon Erratics LLC · Source: Prioritized List of Health Services, February 1, 2026 (complete list) · Current funding line: 1–470 through Dec 31, 2026 · NEW = added in Feb 2026 vs. Oct 2025 BH subset
How to read this document: H0023 (behavioral health outreach, $62.97/service, requires modifier HF or HG) is billable when the patient has a diagnosis on any Prioritized List line that includes H0023 in its HCPCS procedure code set. All 35 lines below include H0023. Lines 1–470 are funded through Dec 31, 2026. Lines above 470 are listed for completeness — not currently covered by OHP. Line 210 is funded through non-OHP sources.
OE primary anchor — Line 4 (Substance Use Disorder): Broadest and most directly relevant line for CBO peer outreach. Covers full F10–F19 SUD spectrum at mild, moderate, and severe severity. F1x.10 codes (mild SUD, uncomplicated) are lowest-specificity and most defensible for peer-identified presentations. Z71.51 (drug abuse counseling/referral) is also on Line 4 — a Z-code requiring no confirmed diagnosis, making it the strongest pre-diagnostic billing hook under OAR 410-120-0000.
Open question for Liz Lohrke (OHA, 4/8/26): Does PSS-documented "problematic substance use" (TIP 64 / SAMHSA language) satisfy OAR 410-120-0000's suspected condition standard for H0023 without a formal ICD-10? If a code is required, can MD certify (e.g., F19.10) via chart review of peer documentation without a face-to-face MD encounter? OAR 410-141-3820(3) frames MD-directed peer services as diagnostic services — MD attestation of a peer note may itself constitute a diagnostic act. Also: is Z71.51 viable as a pre-diagnostic billing code under this model?
All Prioritized List lines supporting H0023 — February 1, 2026
| Line | Status | Condition | ICD-10 codes |
|---|---|---|---|
| 4 anchor | funded | Substance Use Disorder (GN 92, 175) | F10.10–F10.11, F10.20–F10.21, F10.91 (alcohol) · F11.10–F11.11, F11.20–F11.21, F11.91 (opioid) · F12.10–F12.11, F12.20–F12.21, F12.91 (cannabis) · F13.10–F13.11, F13.20–F13.21, F13.91 (sedative) · F14.10–F14.11, F14.20–F14.21, F14.91 (cocaine) · F15.10–F15.11, F15.20–F15.21, F15.91 (stimulant/meth) · F16.10–F16.11, F16.20–F16.21, F16.91 (hallucinogen) · F18.10–F18.11, F18.20–F18.21, F18.91 (inhalant) · F19.10–F19.11, F19.20–F19.21, F19.91 (polysubstance) · R11.16 (cannabis cyclic vomiting) · Z71.51 (drug abuse counseling/referral — no confirmed dx required) |
| 7 | funded | Major Depression, Recurrent; Single Episode, Severe (GN 69, 102) | F32.2–F32.5, F32.9, F33.0–F33.3, F33.40–F33.42, F33.9, F53.0 |
| 22 | funded | Schizophrenic Disorders (GN 69, 82) | F20.0–F20.5, F20.81–F20.9, F25.0–F25.9 |
| 26 | funded | Bipolar Disorders (GN 69, 82) | F30.10–F30.9, F31.0, F31.10–F31.9 |
| 96 | funded | Borderline Personality Disorder | F60.3 |
| 121 | funded | ADHD (GN 20) | F90.0–F90.9 |
| 149 | funded | Feeding and Eating Disorders of Infancy or Childhood | F50.82, F98.21–F98.3, R63.31–R63.32 |
| 172 | funded | PTSD (GN 19) | F43.10–F43.12, F51.5 |
| 192 | funded | Autism Spectrum Disorders (GN 75) | F84.0, F84.3–F84.9 |
| 200 new | funded | Chronic Organic Mental Disorders Including Dementias (GN 6, 86, 92, 121) | E51.2, F01.50, F01.511–F01.C4, F02.80, F02.811–F02.C4, F03.90, F03.911–F03.C4, F04, F06.0–F06.2, F06.30–F06.8, F07.0, F07.81, F10.26–F10.27, F10.96–F10.97 (alcohol-induced persisting dementia), F13.26–F13.27, F13.96–F13.97 (sedative-induced), F18.17, F18.27, F18.97, F19.16–F19.17, F19.26–F19.27, F19.96–F19.97 (polysubstance-induced), G30.0–G30.9, G31.01–G31.2, G31.83 |
| 202 | funded | Depression and Other Mood Disorders, Mild or Moderate | F32.0–F32.1, F32.81–F32.89, F32.A, F33.8, F34.0, F34.81–F34.89, F39, N94.3, R45.88 |
| 210 | non-OHP | Non-Substance-Related Addictive Behavioral Disorders | F63.0 (pathological gambling) |
| 250 | funded | Psychological Factors Aggravating Physical Condition (asthma, chronic GI, hypertension) | F54 |
| 275 | funded | Other Psychotic Disorders (GN 82) | F22–F24, F28, F29, F53.1 |
| 280 | funded | Anorexia Nervosa | F50.00, F50.010–F50.029 |
| 288 | funded | Acute Stress Disorder | F43.0, R45.7 |
| 309 | funded | Gender Affirming Treatment (GN 67, 118, 127, 130, 196, 216) | F64.0–F64.9, Z87.890 |
| 378 | funded | Bulimia Nervosa and Unspecified Eating Disorders | F50.20–F50.25, F50.810–F50.819, F50.84–F50.9 |
| 385 | funded | Separation Anxiety Disorder | F93.0 |
| 388 | funded | Panic Disorder; Agoraphobia | F40.00–F40.02, F41.0 |
| 405 | funded | Dissociative Disorders | F44.0–F44.2, F44.81–F44.89, F48.1 |
| 410 | funded | Schizotypal Personality Disorders (GN 180) | F21 |
| 412 | funded | Overanxious Disorder; Generalized Anxiety Disorder; Anxiety Disorder, Unspecified | F41.1–F41.9, F94.0 |
| 418 | funded | Oppositional Defiant Disorder; Conduct Disorder Age 18 or Under (GN 54) | F63.81, F91.0–F91.9 |
| 431 | funded | Persistent Depressive Disorder | F34.1 |
| 436 | funded | Stereotyped Movement Disorder with Self-Injurious Behavior Due to Neurodevelopmental Disorder (GN 126) | F98.4 |
| 443 | funded | Adjustment Disorders | F43.20–F43.9, F98.9, Z62.810–Z62.813, Z62.815–Z62.891, Z62.898, Z63.4, Z63.8, Z65.8–Z65.9, Z71.89 |
| 445 | funded | Tourette's Disorder and Tic Disorders | F95.0–F95.9 |
| 448 | funded | Reactive Attachment Disorder of Infancy or Early Childhood | F94.1–F94.2 |
| 457 | funded | Simple Phobias and Social Anxiety Disorder | F40.10–F40.11, F40.210–F40.9 |
| 461 | funded | Obsessive-Compulsive Disorders | F42.2–F42.9, F45.22, F63.3 |
| 469 | funded | Encopresis Not Due to a Physiological Condition | F98.1 |
| 485 | above 470 | Paraphilias and Other Psychosexual Disorders | F65.0–F65.4, F65.50–F65.9, F66 |
| 510 new | above 470 | Sexual Dysfunction | F10.181, F10.281, F10.981, F11.181, F11.281, F11.981, F12.188, F12.288, F12.988, F13.181, F13.281, F13.981, F14.181, F14.281, F14.981, F15.181, F15.281, F15.981, F19.181, F19.281, F19.981, F52.0–F52.1, F52.21–F52.9, N52.01–N52.9, N53.11–N53.19, R37 |
| 533 new | above 470 | Impulse Disorders (GN 58) | F63.1–F63.2, F63.89–F63.9 |
| 538 new | above 470 | Somatic Symptoms and Related Disorders | F44.4–F44.7, F44.9, F45.0–F45.1, F45.20–F45.21, F45.29–F45.41, F45.8–F45.9, F68.10–F68.A |
| 560 new | above 470 | Personality Disorders Excluding Borderline and Schizotypal | F60.0–F60.2, F60.4–F60.7, F60.81–F60.9, F68.8, F69 |
Line 62 note — Substance-Induced Mood/Anxiety/Delusional/OCD Disorders: H0038 appears on Line 62 but H0023 does NOT. Peer outreach to persons with substance-induced secondary psychiatric disorders should be billed under Line 4 (the underlying SUD), not Line 62. The F1x.14/F1x.15x/F1x.24 specifier codes on Line 62 are distinct from the base SUD codes on Line 4.
Key codes for OE SUD outreach — Line 4 expanded
| ICD-10 | Description | OE relevance |
|---|---|---|
| F10.10 | Alcohol use disorder, mild, uncomplicated | Lowest-specificity alcohol code; defensible for peer-identified presentation |
| F11.10 | Opioid use disorder, mild, uncomplicated | Primary code for opioid outreach |
| F15.10 | Stimulant use disorder, mild, uncomplicated (includes methamphetamine) | Highest volume for OE CBOs in Linn/Benton/Lincoln counties |
| F19.10 | Other psychoactive substance use disorder, mild, uncomplicated | Polysubstance / unspecified; broadest defensible code; maps most closely to TIP 64 "problematic substance use" framing |
| Z71.51 | Drug abuse counseling and surveillance of drug abuser | Z-code — does not require confirmed diagnosis. Strongest pre-diagnostic billing hook under OAR 410-120-0000. Confirm viability with Liz Lohrke 4/8/26. |
Regulatory framework for H0023 pre-diagnostic billing
| Authority | Provision | OE relevance |
|---|---|---|
| OAR 410-120-0000 | Medical necessity: services appropriate for the diagnosis or treatment of a suspected or confirmed medical condition. Suspected conditions support billing. | Primary authority for pre-diagnostic H0023. Peer-documented problematic substance use may constitute a suspected condition. |
| OAR 410-141-3820(3) | MD-directed peer services as diagnostic services — mandatory OHP coverage, rate-protected, independent of Prioritized List position. | If MD chart review + attestation of peer note = diagnostic act, H0023 without face-to-face MD encounter may be supportable. |
| TIP 64 (SAMHSA 2023) | Defines "problematic substance use" as the target population for peer outreach — a functional pre-diagnostic category. | Supports argument that peer-identified presentation, documented and MD-attested, satisfies the suspected condition standard. |
| BH Fee Schedule (Feb 2026) | H0023 outreach: $62.97/service. Required modifier HF (SUD) or HG (MH). No PA. TN applicable. | HF for SUD-focused CBO outreach. Confirm per-encounter vs. program-level modifier election with OHA. |
Primary source: Prioritized List of Health Services, February 1, 2026 (complete list, Walker Liz, Oregon Health Authority). H0023 line extraction from full HCPCS code sets per condition-treatment pair. Compared against: BH Services Subset, October 1, 2025. New in Feb 2026: Line 200 (Chronic Organic Mental Disorders — funded, H0023 added); Lines 510, 533, 538, 560 (above funding line 470 — not currently covered by OHP). Several line numbers shifted by 1–2 positions; all funded-range lines confirmed within 1–470. Open questions flagged for OHA meeting 4/8/26. Internal OE reference only. Not legal or billing advice. Oregon Erratics LLC · david@oregonerratics.com