Billing Requirements for H0004 and 2b Denial Code

Date: 12/29/25

On November 20, 2025, Meridian began validating claims containing procedure code H0004 to following Illinois Medicaid regulations for billing this procedure code.

• If you are a provider who has been attested by HFS as an HFS Provider Type 98 – Traumatic Brain Injury Waiver Provider - and your therapy services have been authorized by Meridian to provide services to a member who is part of the HCBS Waiver program, you must bill your Medicaid ID (NOT your NPI) with the appropriate procedure code and modifier combinations denoted below:
  
  • H0004 HO (Behavioral Services Master’s Degree Level (MA)
    or
  • H0004 HP (Behavioral Services Doctoral Level (PHD)
  
  Please refer to the IAMHP Comprehensive Billing Guide for more information on billing HCBW Waiver Service. Additionally, please refer to this provider notice from Meridian on this topic from 11/12/2025.
• If you are a provider that is part of medical group billing for services or a sole proprietor and rendering services as one of these registered provider types with HFS of:
  
  • HFS Provider Type 86 – Licensed Clinical Social Worker (LCSW)
  • HFS Provider Type 87- Psychologist (LCP- Licensed Clinical Psychologist)
  • HFS Provider Type 88- Includes:
    
    • Licensed Marriage and Family Therapist
    • Licensed Clinical Professional Counselor
  
  H0004 is not an allowed code to bill in this scenario. Claims will deny EX2b- PROCEDURE NOT COMPATIBLE WITH PROVIDER TYPE*
  
  Services that are allowed to be billed are found on the HFS LPHA Fee Schedule (PDF).
  
  Your claims will be denied if you use H0004 in this scenario.
• If you are a provider that is employed as part of the following HFS array of specialty behavioral health clinics of:
  
  • HFS Provider Type 27- Behavioral Health Center (BHC)
  • HFS Provider Type 36 – Community Mental Health Provider (CMHC)
  • HFS Provider Type 75- Department of Alcohol and Substance Abuse Provider (SUPR)
  • HFS Provider Type 113- Certified Community Behavioral Health Clinic (CCBHC)
  
  H0004 is allowed to be billed but MUST following the specific billing requirements for these provider types as denoted in the IAMHP Comprehensive Billing Guide by each HFS provider type that you are a part of.
  
  A key component to billing out of these clinics is that the billing loop MUST have the NPI of the HFS registered specialty behavioral clinic in the billing loop of the claim.
  
  Please refer to the following depiction of the billing needs for these types of clinics:
  
  

Questions? Please contact Provider Services at 866-606-3700 or reach out to your Provider Relations contact.

*CARC 8