H0015 Billing Rules and Rates in Oregon, Washington, and Idaho

As of September 2026, H0015 is an active, reimbursed intensive outpatient program (IOP) code under Oregon Medicaid fee-for-service, paid at $120.09 per service, and under Idaho Medicaid, paid at $154.32 per diem through Magellan's Idaho Behavioral Health Plan (IBHP) network effective July 1, 2026. Washington's HCA SUD fee-for-service billing guide does not list H0015: Washington pays for the same level of care through itemized component codes for substance use disorder (SUD) programs and through code S9480 with the HK modifier for mental health IOP. Operators running a multi-state IOP book cannot use one billing logic across all three states, and claims built on a single H0015 rule set will deny in Washington.

What Does H0015 Actually Cover?

H0015 is a HCPCS Level II code defined as "alcohol and/or drug services, intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education." It is a bundled, per-service-day code: one line covers the full day's programming rather than itemizing individual and group therapy hours separately. Clinically, it corresponds to ASAM Level 2.1 (intensive outpatient), the tier between standard outpatient (Level 1) and partial hospitalization (Level 2.5).

Because H0015 bundles an entire day of programming into one claim line, whether a state's Medicaid program accepts it at all is a structural billing decision, not a minor technicality, and that decision differs across Oregon, Washington, and Idaho. Connecting ASAM Level 2.1 placement to each state's authorization and billing rules is part of our addiction treatment center consulting.

How Much Does Oregon Medicaid Pay for H0015?

Oregon Health Authority's current Behavioral Health Fee Schedule lists H0015 at $120.09 per service (one billed unit equals one day of IOP programming), payable to providers operating within an OHA-certified SUD program. The two modifiers that matter:

• HF. HF indicates delivery in an OHA-certified substance use disorder program. HG indicates an OHA-certified opioid addiction treatment program. The fee schedule requires one of these modifiers; other modifiers may also apply. The code will deny without it.
• GT. Added when the session was delivered via interactive audio-video telehealth rather than in person.

Fee-for-service claims are governed by OAR 410-172-0640, which sets Oregon's Medicaid behavioral health rate-setting methodology, and the underlying program design sits under OAR chapter 309, division 19 (Outpatient Behavioral Health Services), which is the same rule set our Oregon IOP licensing guide walks through for program design and COA approval.

The caveat every operator needs: most Oregon Medicaid members are enrolled in a Coordinated Care Organization (CareOregon, Trillium, PacificSource, Health Share, and others), not fee-for-service. The $120.09 FFS rate is the state's reference floor; CCO-contracted rates for H0015 are negotiated separately and can run higher or lower depending on the plan and your credentialing leverage. Our Oregon CCO contracting playbook covers how to negotiate against that floor rather than simply accepting it.

Why Doesn't Washington Apple Health Use H0015 for IOP?

This is the fact that catches multi-state operators off guard. Washington's Substance Use Disorder (SUD) Fee-for-Service Billing Guide (effective October 1, 2026) does not list H0015 anywhere in its outpatient SUD coverage table. Washington instead requires SUD IOP to be billed as itemized component services under WAC 246-341-0640 documentation standards:

• H0004. Individual therapy, billed per 15 minutes, modifier HF.
• 96164 / 96165. Group health behavior intervention, initial 30 minutes and each additional 15 minutes, modifier HF.
• 96167 to 96171. Family health behavior intervention codes, with and without the client present, modifier HF.

A day of IOP programming in Washington is reconstructed from several line items rather than billed as one bundled H0015 claim. For mental health IOP specifically (as opposed to SUD IOP), Washington's Mental Health Services Billing Guide (effective October 1, 2026) uses a different bundled code entirely: S9480 ("intensive outpatient psychiatric services, per diem"), billed with the HK modifier under provider taxonomy 251S00000X, and only by behavioral health agencies, not by individual practitioners. Confusingly, S9480 appears elsewhere in the same guide as a "high intensity treatment" code that is explicitly excluded from IOP use; it only applies to IOP and PHP when billed under the dedicated behavioral health agency taxonomy with the HK modifier. Get that modifier or taxonomy wrong and the claim denies regardless of clinical documentation.

Licensure itself runs through WAC 246-341, the same chapter covered in our Washington IOP licensing guide, but licensure and billing are two separate systems here, and a program that is correctly certified can still bill incorrectly if it assumes Oregon's H0015 logic carries over.

What Does Idaho Medicaid Pay for H0015 Through Magellan?

Most Idaho Medicaid behavioral health claims go through Magellan's IBHP rather than a state fee-for-service system. FQHCs, RHCs and IHCPs have a separate fee-for-service schedule. Nearly all Idaho Medicaid behavioral health revenue runs through Magellan Healthcare, Idaho Medicaid's managed care contractor for the Idaho Behavioral Health Plan (IBHP). Magellan's published IBHP outpatient rate schedule pays Idaho Medicaid claims for H0015 at $154.32 per diem, effective July 1, 2026, explicitly mapped to ASAM Level 2.1 substance use disorder programming. The rate is uniform across provider types (physician, psychologist, master's-level clinician, and APRN/PA), which simplifies staffing-mix billing decisions relative to Oregon and Washington's provider-type-differentiated schedules.

The practical gate in Idaho is not the code, since H0015 works and pays well. It is network access. Because Idaho regulates SUD programs through Idaho Code title 39, chapter 3 (which replaced IDAPA 16.07.17 in July 2025) rather than a conventional state facility license, and because Magellan is the sole payer conduit, an IOP program cannot generate H0015 revenue in Idaho until it clears Magellan's IBHP credentialing and contracting process. Our Magellan of Idaho enrollment guide covers that process in detail; it is the real bottleneck between "licensed" and "billing."

Rule status. Idaho moved its substance use disorder service rules from IDAPA 16.07.17 into Title 39, Chapter 3 of Idaho Code through Senate Bill 1024, effective July 1, 2025. The bill's Statement of Purpose says it does not increase or reduce service levels. The residential accreditation requirement now names CARF only, where the former rule also accepted the Joint Commission and the Council on Accreditation. References to IDAPA 16.07.17 in this article point to the final published version of the rule.

H0015 Billing at a Glance: Oregon vs. Washington vs. Idaho

What Are the Most Common H0015 Denial Reasons in Each State?

• Oregon, missing the HF modifier. Claims submitted without HF, or from a program that is not currently OHA-certified as a chemical dependency facility, deny outright regardless of documentation quality.
• Oregon, billing the CCO at the FFS rate. Submitting claims to a CCO using the fee-for-service rate as an assumed contracted rate, rather than the plan's actual negotiated rate, produces underpayments that look like "processing errors" but are really a contracting gap.
• Washington, billing H0015. This is the single most expensive mistake a multi-state operator makes: treating Washington like Oregon and submitting a bundled H0015 claim. Washington's HCA SUD fee-for-service billing guide does not list H0015. It lists component codes such as H0004 with HF, 96164/96165 with HF, and 96167, 96168, 96170 and 96171 with HF. Confirm IOP billing rules with each Apple Health MCO.
• Washington, S9480 without the HK modifier or correct taxonomy. Because S9480 is excluded from IOP use in one part of the billing guide and required for IOP use in another, claims filed under the wrong taxonomy or missing HK are frequently denied even when clinically appropriate.
• Idaho Medicaid, billing before Magellan credentialing is complete. A facility can be fully IDAPA-compliant and nationally accredited and still see every H0015 claim reject if IBHP network enrollment has not finished processing.

How Should a Multi-State IOP Operator Structure Its Billing Workflow?

Programs operating IOP in more than one of these three states need state-specific billing logic built into intake and claims workflows from day one, not retrofitted after the first denial batch. In practice that means:

• Separate claim templates by state. Oregon and Idaho can use a bundled per-diem template built around H0015; Washington needs an itemized-service template built around individual, group, and family component codes, or S9480 for mental health IOP specifically.
• Payer-source flags at intake. For Oregon and Washington, flag whether the client is FFS or CCO/MCO-enrolled at intake, since the billing pathway and the applicable rate depend on it.
• Credentialing status as a billing gate. In Idaho, tie IBHP network status to a hard stop in the billing workflow so claims are not generated, and denied, before Magellan enrollment finalizes.
• Modifier audits on a monthly cadence. HF, GT, and HK are the difference between a paid claim and a denial in this billing niche; a monthly modifier audit catches drift before it becomes a denial backlog.

How Do Commercial Insurance Plans Bill IOP?

Everything above is Medicaid. Commercial insurance plans usually want IOP billed a different way: on a UB-04 institutional claim with a revenue code, not on a professional claim with the HCPCS code alone. The usual pairings are revenue code 0906 (intensive outpatient, chemical dependency) with H0015 for substance use disorder IOP, and revenue code 0905 (intensive outpatient, psychiatric) with S9480 for mental health IOP. CareSource's Marketplace behavioral health fee schedule lists exactly those pairings, and Blue Cross Blue Shield of Michigan requires revenue codes 0905 and 0906 on commercial IOP claims. Each plan sets its own rules in its provider manual and your contract, so confirm the claim form, revenue code and HCPCS pairing with every payer before the first claim goes out.

Commercial rates are also typically higher. In our billing work, commercial plans usually pay in the range of $300 to $550 per day for IOP, depending on the plan, the contract and the program, compared with $120.09 under Oregon Medicaid fee-for-service and $154.32 under Idaho Medicaid. That gap is why the commercial claim format, and a negotiated contract rather than the first rate offered, matter so much to an IOP program's revenue. For commercial residential billing, revenue code 1002, and payer negotiation, see our guide to commercial residential SUD billing in Oregon, Washington, and Idaho. Commercial IOP also carries an authorization that has to be renewed during treatment; our guide to holding an authorization through concurrent review covers the clocks and the packet.

H0015 Billing FAQs

Is H0015 a valid billing code in Washington?

No. As of April 2026, Washington Apple Health's SUD and mental health fee-for-service billing guides do not include H0015 in their coverage tables. Washington bills SUD IOP as itemized component codes and mental health IOP as S9480 with the HK modifier.

How much does Oregon Medicaid pay for H0015?

Oregon Health Authority's current fee-for-service Behavioral Health Fee Schedule pays $120.09 per service for H0015 with the HF modifier. CCO-contracted rates, which cover most Oregon Medicaid members, are negotiated separately from this FFS reference rate.

What is Idaho's Medicaid rate for H0015?

Idaho Medicaid pays $154.32 per diem for H0015 through Magellan of Idaho, which runs the Idaho Behavioral Health Plan (IBHP), Idaho Medicaid's behavioral health managed care plan. The rate is effective July 1, 2026, and is the same for physician, psychologist, master's-level, and APRN/PA provider types.

Does H0015 require prior authorization?

For Idaho Medicaid, Magellan's IBHP Provider Handbook Supplement, effective August 1, 2026, requires prior authorization for intensive outpatient (ASAM 2.1) services for members 18 and older after a threshold of 50 units, and has no authorization requirement for members 17 and under. Magellan IBHP network credentialing must also be completed before any claim pays. Washington's question is moot for H0015 specifically, since the code is not covered there.

How do commercial insurance plans bill H0015?

Most commercial plans want IOP billed on a UB-04 institutional claim with a revenue code, usually 0906 with H0015 for substance use disorder IOP or 0905 with S9480 for mental health IOP. Rules vary by plan, so confirm with each payer. In our billing work, commercial plans usually pay in the range of $300 to $550 per day for IOP, well above Medicaid.

What ASAM level does H0015 correspond to?

H0015 maps to ASAM Level 2.1, intensive outpatient treatment, the tier between standard outpatient (Level 1) and partial hospitalization (Level 2.5).

Can the same clinical program bill differently in each state without changing its services?

Yes, and it should. The clinical program (hours per week, staffing, individualized treatment plan) can be identical across Oregon, Washington, and Idaho locations under ASAM 2.1 criteria; only the billing code, modifier, and claims structure need to change by state.

Getting H0015 Billing Right the First Time

Getting IOP billing right across Oregon, Washington, and Idaho is not a documentation problem. It is a systems problem: the wrong code, the wrong modifier, or a credentialing gap that closes long after the clinical team has already delivered the service. Saint Health Group builds the billing infrastructure alongside the clinical and licensing work rather than treating revenue cycle as an afterthought. We write the payer-contracting strategy, set up state-specific claim logic, manage payer contracting and credentialing, and run the billing operations that keep H0015, and every other code your program depends on, actually getting paid. If H0015 claims are already going out and you are not sure what they collect, start with our free 90 day claims review; it shows where the IOP dollars stop. If your IOP program spans more than one of these three states, or you are launching in a new one, talk to our team about building a billing workflow that matches each state's rules instead of assuming they are all the same.