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HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

HCPCS Level II code H0005 denotes clinician-delivered group counseling for alcohol and/or drug services. This code identifies a common behavioral health intervention used in outpatient and community treatment settings to provide structured group therapy for individuals with substance use disorders. Nationally, H0005 matters because group counseling is a key, cost-effective component of comprehensive addiction treatment and is widely used across payers and care settings.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and coverage patterns for H0005, context on its clinical role in substance use treatment, and discussion of common billing considerations that influence reimbursement and program design. The publication highlights variations in coverage policies, typical service settings where the code is billed, and how H0005 fits within broader behavioral health service lines.

This summary serves clinicians, billing professionals, and policy analysts seeking an overview of the code’s clinical purpose, payer relevance, and the types of information to consult when evaluating coverage and utilization of clinician-led group counseling services for substance use.

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Billing Code Overview

HCPCS Level II code H0005 represents alcohol and/or drug services: group counseling delivered by a clinician. The service type is behavioral health group counseling, typically involving therapeutic group sessions focused on substance use disorders. The typical site of service for H0005 includes outpatient behavioral health clinics, community mental health centers, substance use treatment programs, and other ambulatory settings where clinician-led group therapy is provided.

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HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

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Billing Code Overview

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Clinical & Coding Specifications

Clinical Context

A typical patient is a 32-year-old adult diagnosed with alcohol use disorder who attends a scheduled group counseling session at an outpatient behavioral health clinic. The group is led by a licensed clinician (such as a licensed clinical social worker or substance use counselor) and consists of 6–10 participants meeting for 60 minutes to discuss coping strategies, relapse prevention, and psychoeducation. The workflow begins with patient check-in and brief screening for acute intoxication or withdrawal, followed by a clinician-led check-in, structured therapeutic interventions (cognitive-behavioral techniques, motivational interviewing), and documentation of attendance, group content, and progress in the electronic health record. Billing staff apply the H0005 HCPCS Level II code for group counseling by a clinician, attach appropriate modifiers if applicable, and ensure the visit is linked to the participant’s primary substance-related ICD-10 diagnosis in the chart for claims submission.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When a separately identifiable service distinct from other services on the same day is provided (rare for group counseling but applicable if a distinct service is rendered).
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the group counseling session is delivered live via telehealth with audio and video.
`GT`	Via interactive audio and video telecommunications system	Alternate payer-specific telehealth modifier used when `95` is not required.
`52`	Reduced services	When the group session is substantially shortened or truncated but still provided.
`53`	Discontinued procedure	If the group session is started but aborted due to an emergency or patient safety concern.
`59`	Distinct procedural service	When an individual service that is separate and independent from the group session occurs on the same day.
`QK`	Qualified nonphysician health professional-service	When services are furnished by a qualified nonphysician health professional under Medicare waiver or specific payer rules.
`QX`	Services performed by an auxiliary personnel with modifier `QY` or `QK` relationship	When an auxiliary staff member provides the service under appropriate supervision and payer requires the modifier.
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	When the group counseling occurs in a separate encounter from other billed services on the same day.
`XP`	Separate practitioner, service performed by a different practitioner	When another clinician on the same day provides a distinct service.
`XU`	Unusual non-overlapping service	When the group counseling is distinctly different and not overlapping with other services on the same day.
`22`	Increased procedural services	When the group session required substantially greater work than typical (document justification required).
`52`	Reduced services	When the service is partially reduced or not completed (billing reduction applied).

Taxonomy Code	Specialty	Notes
`163W00000X`	Addiction Medicine	Clinicians specializing in medical management of substance use disorders; may coordinate group therapy.
`1041C0700X`	Clinical Social Worker	Common provider type leading group counseling sessions in outpatient behavioral health settings.
`101Y00000X`	Mental Health Counselor	Licensed professional typically delivering group counseling for substance use disorders.
`106H00000X`	Marriage and Family Therapist	May provide family-oriented or group counseling focused on substance-related issues.
`103T00000X`	Psychologist	Provides group psychotherapy or co-facilitates substance use disorder groups.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F10.20`	Alcohol dependence, uncomplicated	Common primary diagnosis for outpatient group counseling targeting alcohol use disorder.
`F11.20`	Opioid dependence, uncomplicated	Substance-specific group counseling may address opioid use disorder treatment and relapse prevention.
`F12.20`	Cannabis dependence, uncomplicated	Group counseling used for behavioral interventions targeting cannabis dependence.
`F13.20`	Sedative, hypnotic or anxiolytic dependence, uncomplicated	Group therapy can support recovery and coping strategies for sedative dependence.
`F14.20`	Cocaine dependence, uncomplicated	Group counseling addresses stimulant use disorders with relapse prevention focus.
`F15.20`	Other stimulant dependence, uncomplicated	Includes amphetamines; group interventions target stimulant-related behaviors.
`F19.20`	Other psychoactive substance dependence, uncomplicated	Captures mixed or unspecified substance dependence where group counseling is applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often used for initial assessment before enrollment in group counseling to establish diagnosis and treatment plan.
`90853`	Group psychotherapy (other than of a multiple-family group)	Closely related therapy code; payers may require `H0005` for substance-specific group counseling while `90853` is used for psychotherapy groups.
`99408`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; 15 to 30 minutes	Used for brief interventions that may precede or follow group sessions for screening and brief counseling.
`99409`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; greater than 30 minutes	Used when brief intervention exceeds 30 minutes as part of intake or follow-up.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory)	Utilized for standardized symptom monitoring before, during, or after group treatment to track outcomes.

HCPCS H0001: Alcohol and/or Drug Assessment

HCPCS-H0002-BEHAVIORAL-HEALTH-SCREENING-ADMISSION-ELIGIBILITY

HCPCS H0002: Behavioral Health Screening for Admission to Treatment Program

HCPCS-H0003-ALCOHOL-DRUG-SCREENING-LAB-ANALYSIS

HCPCS H0003: Alcohol and/or Drug Screening, Laboratory Analysis

HCPCS-H0004-BEHAVIORAL-HEALTH-COUNSELING-15-MINUTE

HCPCS H0004: Behavioral Health Counseling and Therapy, 15 Minutes

HCPCS-H0006-ALCOHOL-DRUG-CASE-MANAGEMENT

HCPCS H0006: Alcohol and/or Drug Services, Case Management

HCPCS-H0007-ALCOHOL-DRUG-CRISIS-INTERVENTION-OUTPATIENT

HCPCS H0007: Alcohol and/or Drug Crisis Intervention, Outpatient

HCPCS-H0008-SUB-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

HCPCS H0008: Sub-acute Detoxification, Hospital Inpatient

HCPCS-H0009-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

HCPCS H0009: Alcohol and/or Drug Services, Acute Detoxification (Hospital Inpatient)

HCPCS-H0010-SUB-ACUTE-RESIDENTIAL-DETOXIFICATION

HCPCS H0010: Sub-Acute Residential Detoxification Services

HCPCS-H0011-ACUTE-DETOXIFICATION-RESIDENTIAL-INPATIENT

HCPCS H0011: Acute Detoxification, Residential Inpatient

Showing 1–10 of 93

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When a separately identifiable service distinct from other services on the same day is provided (rare for group counseling but applicable if a distinct service is rendered).
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the group counseling session is delivered live via telehealth with audio and video.
`GT`	Via interactive audio and video telecommunications system	Alternate payer-specific telehealth modifier used when `95` is not required.
`52`	Reduced services	When the group session is substantially shortened or truncated but still provided.
`53`	Discontinued procedure	If the group session is started but aborted due to an emergency or patient safety concern.
`59`	Distinct procedural service	When an individual service that is separate and independent from the group session occurs on the same day.
`QK`	Qualified nonphysician health professional-service	When services are furnished by a qualified nonphysician health professional under Medicare waiver or specific payer rules.
`QX`	Services performed by an auxiliary personnel with modifier `QY` or `QK` relationship	When an auxiliary staff member provides the service under appropriate supervision and payer requires the modifier.
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	When the group counseling occurs in a separate encounter from other billed services on the same day.
`XP`	Separate practitioner, service performed by a different practitioner	When another clinician on the same day provides a distinct service.
`XU`	Unusual non-overlapping service	When the group counseling is distinctly different and not overlapping with other services on the same day.
`22`	Increased procedural services	When the group session required substantially greater work than typical (document justification required).
`52`	Reduced services	When the service is partially reduced or not completed (billing reduction applied).

Taxonomy Code	Specialty	Notes
`163W00000X`	Addiction Medicine	Clinicians specializing in medical management of substance use disorders; may coordinate group therapy.
`1041C0700X`	Clinical Social Worker	Common provider type leading group counseling sessions in outpatient behavioral health settings.
`101Y00000X`	Mental Health Counselor	Licensed professional typically delivering group counseling for substance use disorders.
`106H00000X`	Marriage and Family Therapist	May provide family-oriented or group counseling focused on substance-related issues.
`103T00000X`	Psychologist	Provides group psychotherapy or co-facilitates substance use disorder groups.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F10.20`	Alcohol dependence, uncomplicated	Common primary diagnosis for outpatient group counseling targeting alcohol use disorder.
`F11.20`	Opioid dependence, uncomplicated	Substance-specific group counseling may address opioid use disorder treatment and relapse prevention.
`F12.20`	Cannabis dependence, uncomplicated	Group counseling used for behavioral interventions targeting cannabis dependence.
`F13.20`	Sedative, hypnotic or anxiolytic dependence, uncomplicated	Group therapy can support recovery and coping strategies for sedative dependence.
`F14.20`	Cocaine dependence, uncomplicated	Group counseling addresses stimulant use disorders with relapse prevention focus.
`F15.20`	Other stimulant dependence, uncomplicated	Includes amphetamines; group interventions target stimulant-related behaviors.
`F19.20`	Other psychoactive substance dependence, uncomplicated	Captures mixed or unspecified substance dependence where group counseling is applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often used for initial assessment before enrollment in group counseling to establish diagnosis and treatment plan.
`90853`	Group psychotherapy (other than of a multiple-family group)	Closely related therapy code; payers may require `H0005` for substance-specific group counseling while `90853` is used for psychotherapy groups.
`99408`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; 15 to 30 minutes	Used for brief interventions that may precede or follow group sessions for screening and brief counseling.
`99409`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; greater than 30 minutes	Used when brief intervention exceeds 30 minutes as part of intake or follow-up.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory)	Utilized for standardized symptom monitoring before, during, or after group treatment to track outcomes.

HCPCS H0001: Alcohol and/or Drug Assessment

HCPCS-H0002-BEHAVIORAL-HEALTH-SCREENING-ADMISSION-ELIGIBILITY

HCPCS H0002: Behavioral Health Screening for Admission to Treatment Program

HCPCS-H0003-ALCOHOL-DRUG-SCREENING-LAB-ANALYSIS

HCPCS H0003: Alcohol and/or Drug Screening, Laboratory Analysis

HCPCS-H0004-BEHAVIORAL-HEALTH-COUNSELING-15-MINUTE

HCPCS H0004: Behavioral Health Counseling and Therapy, 15 Minutes

HCPCS-H0006-ALCOHOL-DRUG-CASE-MANAGEMENT

HCPCS H0006: Alcohol and/or Drug Services, Case Management

HCPCS-H0007-ALCOHOL-DRUG-CRISIS-INTERVENTION-OUTPATIENT

HCPCS H0007: Alcohol and/or Drug Crisis Intervention, Outpatient

HCPCS-H0008-SUB-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

HCPCS H0008: Sub-acute Detoxification, Hospital Inpatient

HCPCS-H0009-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

HCPCS H0009: Alcohol and/or Drug Services, Acute Detoxification (Hospital Inpatient)

HCPCS-H0010-SUB-ACUTE-RESIDENTIAL-DETOXIFICATION

HCPCS H0010: Sub-Acute Residential Detoxification Services

HCPCS-H0011-ACUTE-DETOXIFICATION-RESIDENTIAL-INPATIENT

HCPCS H0011: Acute Detoxification, Residential Inpatient

Showing 1–10 of 93

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

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Billing Code Overview

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HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

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Billing Code Overview

HCPCS H0005: Alcohol/Drug Group Counseling by a Clinician

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What service does HCPCS code H0005 represent and where is it typically provided?

Which related CPT or HCPCS codes are commonly billed alongside H0005?

What modifiers and provider taxonomy types are relevant when billing H0005?

Which primary diagnoses are appropriate to link to H0005 on claims and what documentation is noted in the clinical context?

Which payers are referenced for H0005 and how might payer policies affect billing?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What service does HCPCS code H0005 represent and where is it typically provided?

Which related CPT or HCPCS codes are commonly billed alongside H0005?

What modifiers and provider taxonomy types are relevant when billing H0005?

Which primary diagnoses are appropriate to link to H0005 on claims and what documentation is noted in the clinical context?

Which payers are referenced for H0005 and how might payer policies affect billing?

References