Oregon peer support billing — fee schedule reference
Oregon Erratics LLC · Source: OHA BH Fee Schedule (Feb 2026) · OHA Peer-Delivered Services Billing Guide (Oct 2025) · RR = routine/regular (no PA). PA = prior authorization required.
Core peer billing codes
H0038 — Self-help / peer services (per 15 min)
| Modifier condition | Rate | Managed | Allowed modifiers |
|---|---|---|---|
| Base rate (no HK) | $26.49 / 15 min $105.96/hr equivalent | RR | GT TN U9 HH HO |
| HK required — specialized mental health | $33.12 / 15 min $132.48/hr equivalent | PA | GT TN U9 HH HO |
OE notes: TN (rural) at 127% of base = ~$33.64/unit base, ~$42.06/unit with HK. QDP/TBHA (110%) stacking with TN pending written OHA confirmation — do not bill stacked until confirmed. GT = telehealth. U9 = OHP member. Fee schedule footnote confirms: delivered by certified Peer Support Specialist, Peer Wellness Specialist, or Certified Recovery Mentor.
H0023 — Behavioral health / alcohol and drug outreach
| Description | Rate | Required modifier | Allowed modifiers | Managed |
|---|---|---|---|---|
| Alcohol and/or drug outreach — planned approach to reach a targeted population | $62.97 / service | HF or HG | TN U9 HH HO | RR |
| Intensive In-Home Behavioral Health Treatment Services (IIBHT) | $4,169.71 / month / member | — | TN U9 HH HO | RR |
Important: H0023 outreach requires modifier HF (substance abuse program) or HG (mental health program) — at least one required. HF vs HG must match presenting population/program type. Per-service billing (not per 15 min). OAR 410-120-0000 supports billing for suspected/unconfirmed conditions — anchors pre-diagnostic outreach under MD standing order.
Open billing question: Does PSS identification of "problematic substance use" (TIP 64 language) constitute sufficient justification for H0023 without a formal diagnosis? Or can MD certify ICD-10 (F19.10, F10.10, F11.10, etc.) via chart review based on PSS documentation, without a face-to-face MD encounter? Raise with Liz Lohrke — this is the key H0023 justification question for OE's model.
H2011 — Crisis intervention services (per 15 min)
| Rate | Managed | Allowed modifiers |
|---|---|---|
| $41.70 / 15 min $166.80/hr equivalent | RR | GT TN U9 HH HO |
Scope caution: TIP 64 (Exhibit 3.4) distinguishes peer crisis support (presence, reassurance, safe space, crisis prevention planning — H0038) from clinical crisis intervention (risk assessment, safety planning, involuntary holds). Whether peer-delivered Category 8 activities can bill H2011 vs H0038 requires OHA clarification. Raise with Liz Lohrke.
Scope boundary reference
T1016 — Case management (per 15 min) — boundary reference only, not a peer code
| Modifier condition | Rate | Managed |
|---|---|---|
| Base rate (no HK) | $34.49 / 15 min | RR |
| HK specialized mental health | $43.12 / 15 min | PA |
Differentiation (TIP 64 + SAMHSA 2015): Case management = formal needs assessment, service plan authorship, eligibility determination, administrative interagency coordination. Peer support (H0038) = extends and supports case management relationally — accompaniment, warm handoffs, goal-setting, resource coaching. TIP 64 Exhibit ES.2: a peer worker is not a case manager. Competency Categories 5 and 10 are the primary differentiation zones.
Adjacent codes — awareness
G0177 — Training / educational services (45 min+)
| Rate | HK rate | Managed |
|---|---|---|
| $28.80 | $36.02 | RR / PA |
45-min minimum. Allowed: GT, TN, U9, HH, HO. Typically clinician-delivered — confirm peer eligibility before using. Relevant to Category 7.
H2014 — Skills training and development (per 15 min)
| Rate | HK rate | Managed |
|---|---|---|
| $29.28 | $36.60 | RR / PA |
Allowed: TN, U9, HH, HO (no GT). Category 7 competencies may map here for structured skills training. Confirm scope with OHA.
H2023 — Supported employment / education (per 15 min)
| Variant | Rate | HK | Req. mod |
|---|---|---|---|
| Employment | $26.84 | $33.56 | — |
| Education | $26.84 | $33.56 | HE |
Allowed: GT, TN, U9. Education variant requires HE. Relevant to Categories 5 and 6 with employment/education goals.
H0039 — Assertive community treatment (per 15 min)
| Rate | HK rate | Managed |
|---|---|---|
| $41.66 | $52.08 | RR / PA |
ACT team model — face-to-face. Allowed: GT, TN, U9. Peers in ACT teams can bill this. Requires ACT team structure — not standalone.
Modifier decoder
| Modifier | Meaning | OE relevance |
|---|---|---|
TN | Rural — services delivered in rural setting | 127% rate multiplier. Scio office anchor = rural designation. Confirm per-claim or per-provider basis with OHA. |
U9 | OHP member identifier | Standard on all OHP claims. |
HK | Specialized mental health — triggers PA and higher rate | Prior authorization required. ~25% rate increase. Confirm whether CBO peers qualify. |
HF | Substance abuse program | Required for H0023 outreach targeting SUD population. |
HG | Mental health program | Required for H0023 outreach targeting MH population. HF or HG — pick one per claim. |
GT | Telehealth — interactive audio and video | Enables remote delivery. Not available on H0046 or H2014. |
HH | Integrated mental health/substance abuse program | Applicable when peer works in integrated BH setting. |
HO | Master's level or above | Supervisor-level modifier — not applied to peer-billed claims directly. |
HE | Mental health program — education variant | Required for H2023 supported education line only. |
Modifier stacking — open question: TN (127%) + QDP/TBHA (110%) stacking pending written OHA confirmation. Do not bill stacked modifiers until confirmed. Raise with Liz Lohrke — material for IHN PMEPM negotiations.
Fee schedule footnotes (verbatim)
Peer eligibility: "Peer services may be delivered by certified Peer Support Specialist and Peer Wellness Specialist under the scope of their practice. Peer Support Specialists include Certified Recovery Mentors."
Rules: Chapter 410, Division 172 — Medicaid Behavioral Health Rules · Chapter 309, Division 19 — Outpatient Addictions and Mental Health Services Rules
Resources: comagine.org/program/oregon-behavioral-health-support/providers · OHA Peer Support Billing Guide: oregon.gov/oha/HSD/OHP/Tools/Peer-Support-Billing-Guide.pdf
Source: OHA BH Fee Schedule February 2026 (bh-fee-schedule0226.csv). Rates are OHP fee-for-service; CCO/VBP contracts may vary. RR = routine/regular (no PA). PA = prior authorization required. Open questions for Liz Lohrke (OHA, 4/8/26): (1) H0023 diagnosis justification — PSS-identified problematic substance use vs MD chart review ICD-10 certification; (2) H2011 peer eligibility; (3) TN + QDP/TBHA modifier stacking; (4) Group MMIS enrollment status; (5) BH vs non-BH designation implications. · Internal OE reference only. Not legal or billing advice. · Oregon Erratics LLC · david@oregonerratics.com