Level of care not authorized
Days billed at residential or PHP level after the authorization lapsed or stepped down. We track concurrent review dates per patient and submit clinical updates before the covered period ends.
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Substance abuse treatment medical billing services
Substance abuse treatment billing follows the level of care. Detox, residential, partial hospitalization, intensive outpatient and office-based treatment each carry their own codes, revenue codes and authorization rules, and payers measure every day against ASAM criteria. Claims pay when the level billed matches the clinical record and the authorization on file.
What makes substance abuse treatment billing different
Addiction treatment is billed by program level, not by visit, and that changes nearly every rule a general biller relies on.
- Intensive outpatient and partial hospitalization bill as per diem services, H0015 or S9480 with revenue code 0906 for IOP and H0035 or revenue codes 0912 and 0913 for PHP, with group and individual hours documented each day.
- Medicare opioid treatment programs bill weekly bundles G2067 through G2080 by medication, methadone, oral or injectable buprenorphine, or naltrexone, while office-based treatment uses G2086 through G2088, and neither can overlap a separately billed counseling session.
- Drug testing splits into presumptive codes 80305 to 80307 and definitive codes G0480 to G0483 by analyte count, and payers apply frequency limits and medical necessity policies that require a documented reason for each test ordered.
- Assessment and counseling H-codes, H0001, H0004 and H0005, carry state Medicaid unit definitions and often require modifier HF for the program, and concurrent review deadlines decide whether residential days are covered at all.
Denials we see most in substance abuse treatment
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Drug testing frequency
Definitive testing denied as routine or exceeding plan limits. We match each test to a documented clinical reason, use presumptive codes where appropriate and appeal with the treatment plan.
Revenue code mismatch
Facility claims rejected because the revenue code, HCPCS and units do not agree with the program level. We build a code crosswalk for each payer and scrub every claim against it.
How Core MB bills for substance abuse treatment
Core MB assigns a team that knows ASAM levels, utilization review and the Medicaid rules in your state, works authorizations alongside your clinical staff and keeps Part 2 consent attached to every release. Credentialing for new counselors and sites runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Authorization and concurrent review calendar maintained per patient so step-downs are requested before days go unpaid.
- Per diem claims checked for revenue code, HCPCS, units and service hours before they leave the building.
- Drug testing orders reviewed against payer frequency policies and the documented treatment plan.
Everything in the service
A full revenue cycle built for addiction treatment programs, from benefit verification through facility and professional claims to appeals, posting and reporting your program director can act on.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Substance abuse treatment billing questions
Can we bill individual counseling on the same day as an IOP per diem?
Usually not. Most payers consider H0004 or 90834 bundled into the H0015 or S9480 per diem for that date. We check each payer's bundling rules and document when a separately billable service outside the program hours is justified.
Why do commercial plans keep asking for records on residential days?
Residential care is reviewed against ASAM criteria almost continuously. Plans request records to confirm the patient still meets the level of care. We send concurrent reviews on schedule, with withdrawal scores, progress notes and discharge planning, so coverage is extended before it lapses.
How does 42 CFR Part 2 affect our claims?
Part 2 limits what can be disclosed about a patient in a federally assisted substance use program. Claims and records requests go out only with a valid consent on file, and we maintain the consent inventory so an audit or appeal never exposes the program to a disclosure problem.
How do we get started with Core MB for substance abuse treatment billing?
Tell us your levels of care, sites, provider count and monthly volume through the quote form and we will reply with a written proposal. Transitions run alongside your current billing so no authorization or claim is dropped, and credentialing for new counselors and sites can start at the same time.
More in behavioral health
Billing that keeps pace with every level of care
Authorizations tracked, per diem claims coded correctly and drug testing defended, so your program can focus on recovery instead of chasing payers.