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Mental Health Billing Services (MHBS) bills outpatient counseling programs, office-based MAT providers, and treatment facilities throughout the country. Our coding complies with current codes and claim information is stored under 42 CFR Part 2. We get back the denials related to special SUD regulations.
What Is Covered by MHBS
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The federal rule on SUD records that shapes how every claim moves
The ICD-10 families where diagnosis precision prevents denials
Nationwide SUD billing across Medicaid, commercial, and Medicare
The term substance abuse billing means the process of claiming payment for the services provided during treating a substance use disorder. This includes processes like detox, outpatient therapy, intensive outpatient therapy, medication-assisted treatment, and recovery support. Each of these processes uses different codes and different rules for the billing. The job involves coding, filing, and recovering payments for the services aimed at the treatment of a substance use disorder.
There are three clear distinctions between SUD billing and medical billing. There is a special regulation about the process of handling the information in SUD billing, besides the existing HIPAA regulations. There is usually a level of care determination based on the ASAM criteria needed to make sure there is coverage. Finally, the code of the disease has to be placed into the proper ICD-10 family.
Our billing is solely for behavioral health, and substance use disorder is right at the heart of that practice. Our coders all have AAPC and AHIMA credentials. We verify all our SUD codes against the latest AMA CPT and CMS sources before we even send our claim. That’s billing expertise in one area, not forty different ones.
Your claim gets its code from an AAPC or AHIMA certified coder, who makes sure the code matches up with the documentation and current code sets. You know what happens if you submit a SUD claim with a miscoded claim? Denial or an audit is what happens. Certified coding is the first check we make on your revenue.
We’re a mental health billing service that bills behavioral health alone, so the regulations for SUD are regular fare for us. Carve-outs, ASAM level determinations, and 42 CFR Part 2? That’s just standard operating procedure around here. Your generalist firm will put SUD as one specialty out of forty.
All CPT and HCPCS codes are verified against the latest guidelines published by the AMA and CMS. A defunct code or a wrong H-code will never be billed. Such diligence becomes critical in the heavily regulated specialty of SUD. Our benchmark is a billable claim.
SUD claims get denied for a limited number of reasons. They relate either to the level of care, the need for authorization, the way the diagnoses are coded or the wrong routing by payers. All of them are easily avoided with the right process preceding a claim. These are the five biggest sources of SUD denials.
The care offered at different levels for substance abuse disorders is measured against ASAM level of care criteria. Any claim that does not meet the requirements of the criteria gets denied due to lack of medical necessity. The document needs to provide the justification for the care provided at this level, not for the service alone.
Higher levels of care for substance abuse disorders require concurrent review of treatment. The provider has blocks of days authorized that should be renewed during treatment. Failure to undergo a concurrent review means that all the delivered days turn out to be unbilled.
Certain higher levels of care require concurrent review. Days are approved in chunks, not all at once. The lack of concurrent review renders any provided care into unauthorized days. This is the quickest way for the facility to lose money through leakage.
The vast majority of substance use disorder benefits are provided under a carve out plan or Medicaid MCO arrangement. If you route the claim to the medical plan, you receive no response. The carved-out plan provides the benefit; it should be routed to the behavioral health billing pillar.
The payer expects each visit to relate to the treatment plan in some way. Documentation that only states patient attendance and does not document progress is custodial in nature. Each service must relate to a goal in the treatment plan.
The SUD billing service provides a complete cycle of revenue generation to your practice. It includes eligibility, credentialing, coding, claim submission, and denial management processes. Each of the processes has its unique SUD perspective, lacking in a general biller.
It ensures that the SUD benefit is available before the treatment begins and also the level of care involved. Treatment programs often operate outside the networks, and we make sure we verify all those aspects too. The task is located on our eligibility verification page.
We enroll the SUD counselors as well as programs with each payer using the correct taxonomy. Titles like LADC, CADC, and CASAC differ from one state to another, which affects panel access. Also, each program requires facility-level credentialing. This task is carried out on our credentialing and enrollment page.
Our licensed coders apply codes to the payer’s system based on either H-codes or CPT codes. The F-code diagnosis acts as the foundation for the claim to be filed with adequate specificity. Coding charge entry documents the units based on the coding time rules. Here comes the anti-denial process before submitting the claims.
We file our clean claims and follow each claim until a conclusion is reached. Payments are posted according to the details provided in the remittance advice. An underpayment or partial payment of the claim will be tracked. Each code that is paid by the insurance will have its detail in the remittance advice.
We appeal any SUD denials with regard to their specific reason codes. The level-of-care denial is appealed using the ASAM documentation. We can make appeals under the parity law when a health plan uses a limit which applies to SUD treatments alone. Our appeals process lies in the denial management page.
Want a read on how your SUD claims are coded and paid today? Send 90 days of claims for a free review.
42 CFR Part 2 is the federal privacy regulation covering substance use disorder treatment records. This rule overrides the HIPAA with more stringent consent requirements. It regulates the disclosure of the SUD claim data to payers, among other things. It is revenue protection because if done wrong, the claim will be rejected or expose the program to issues.
Part 2 regulates the disclosure of the records of the SUD treatment program. Disclosure is part of the claims, therefore consent should authorize that. It restricts what information is disclosed to a payer and how. Therefore, the billing processes need to operate within this framework.
Part 2 consent should authorize the particular disclosure made by the claim. We incorporate consent and disclosure within the billing process workflow. The communication to the payers will only occur within the scope authorized by the consent. Sending the claim without consent is non-compliance, not shortcutting.
Part 2 has been harmonized with HIPAA to an extent in recent rulemaking. This will affect the procedures of consents and disclosures related to substance use disorder documentation. The timing and specifics need to be confirmed by referring to the source at the time.
None of the two competitor pages in this area mentions Part 2. For the general medical biller, handling an SUD claim means no more than handling another disclosure. Herein lies the vulnerability of SUD programs. This confidentiality dimension calls for a specialist.
Office-based buprenorphine services use the updated office E/M codes 99202-99215. The 2023 X-waiver elimination impacted the prescribing criteria. The naltrexone injection and Medicare methadone bundle have unique codes each. All codes listed below are updated according to the most recent standards.
An OBOT buprenorphine service is an office E/M service. Starting from 2021, this means the codes 99202-99215 chosen based on either medical decision making or total time. Neither history nor examination determines the level any more. A page still explaining how to choose 99201 code teaches how to choose an obsolete code.
The Consolidated Appropriations Act of 2023 terminated the DATA-2000 X-waiver prescription. Under this Act, a prescriber with a DEA registration can prescribe buprenorphine for opioid use disorder when state laws allow. The special waiver is not needed anymore. It significantly expanded the range of clinicians eligible for MAT prescribing.
An extended-release naltrexone injection is billed in two components. There is one for the drug cost and another for administration. These must be done in pairs to get the whole charge. We need to bill both.
The payment system uses weekly bundled G-codes that cover medication, dispensing, counseling, and toxicology services. OTPs enroll with Medicare and then submit the charges for these codes on a weekly basis. It is important to get the updated codes and rates.
There are three coding systems used in SUD billing. ICD-10 F-Codes are used to denote the diagnosis. HCPCS H-Codes are used to bill Medicaid SUD services. Regular CPT Codes are used to bill psychotherapy in dual-diagnosis treatment. The list of codes below is properly named and validated, unlike many billing websites which refer to their codes in very ambiguous language.
| Code / Code Range | Service or Diagnostic Group | Billing Notes |
|---|---|---|
|
F10–F19 |
ICD-10 substance-related disorder groups covering alcohol through other substances |
Use applicable remission specifiers when supported by the clinical record. |
|
H0001 |
Alcohol or drug assessment and SUD treatment intake |
Medicaid H-code. Rates, units, and coverage rules vary by state program. |
|
H0004 |
Individual behavioral health counseling in an SUD treatment setting |
Commonly billed in 15-minute units under state Medicaid payment schedules. |
|
H0005 |
Clinician-led group counseling in an SUD program |
Medicaid H-code comparable to CPT 90853 in states that require H-codes. |
|
90832–90838 |
Time-based individual psychotherapy for patients with SUD or dual diagnoses |
Commercial payers often prefer these CPT codes when H-codes are not accepted. |
|
99408 / 99409 |
Alcohol and substance misuse screening and brief intervention, commonly called SBIRT |
Time-based codes covering both the screening and brief intervention service. |
There are several practice types in substance use disorder treatment. An outpatient counselor, an OBOT prescriber, and a treatment program bill differently. We provide the billing cycle process for all of these practice types, as well as dual-diagnosis behavioral health practice. The compliance layer is always the same, while the codes and enrollment may change based on the setting.
An LADC, CADC, or CASAC bills outpatient counseling to insurance. The panel access and licensure recognition may differ by the state and payer. H-codes or CPT codes will be used depending on the plan type. We provide the billing codes and enrollment the counselor uses.
A dual diagnosis practice provides treatment for a mental health disorder and a substance use disorder at once. The bill includes the psychotherapy CPT codes and the SUD coding. We keep the two coding systems straight across the visit.
The OBOT prescriber bills office E/M visits along with the buprenorphine treatment. The X-waiver is not needed anymore, which means that there are more practitioners providing this service. The E/M coding needs to be consistent with the current scheme. We bill the treatment and the visit combined.
The level of care involved may be detoxification, residential, or an intensive outpatient program. Institutional claims have their own billing system depending on concurrent reviews and per diem codes. As for the facility side, it has its own home, which will be discussed in the following section.
Facility SUD billing is a whole discipline. Detox, residential, and program-level billings utilize UB-04 institution form, but not the CMS-1500. Per diem pricing, revenue codes, and ASAM residential levels apply. Concurrent reviews have tight timeframes. This kind of billings is included too; it is done using the following forms.
A center is billed differently from an outpatient counselor. Per diem pricing applies to a day of care, not to individual services. Revenue codes and bill types replace professional codes. ASAM residential levels 3.1-3.7 establish the standard of medical necessity. Facility rules in their depth are discussed in our facility SUD billing pages. Detox, residential, PH, and IOP forms constitute separate spokes here. If your organization is running a treatment program, this group of forms will answer your needs.
SUD insurance billing spans all major payer types. Medicaid is the largest payer of substance use disorders in many states via managed care. The commercial plans direct-bill SUDs via carve-outs. Medicare has enrolled addiction counselors in 2024. We monitor the SUD coverage terms for all the payer groups.
Medicaid is the leading payer of SUD coverage in the country. Many states have SUD coverage through the managed care organization. H-codes, rates, and prior authorization vary from state to state and MCO to MCO. We monitor the SUD coverage for each of the states that the practice bills into.
The commercial plans will typically direct-bill SUD coverage via behavioral carve-out. The benefit will be located within the MBCO plan, not the medical plan. This behavioral carve-out is one of the basic aspects of behavioral health billing. Payers tend to favor CPT coding over H-codes.
Medicare covered addiction & mental health counselors as billing providers in 2024. It has expanded the panel of SUD counselors. The employee assistance programs (EAPs) have different rules of referrals and authorizations. We route these into their respective billing processes.
The specialized billing company knows all the nuances that a generalist overlooks. The Part 2 consent, ASAM levels, F-code specifics, and carving out routes – they are all a part of our regular job. A generalist bills SUD along with many other specialties. And this is where the difference emerges, and it is what we cover.
SUD forms the core of a whole book that is devoted to behavioral health only. Generalists apply the same tactics for SUD claims as they do for every other specialty. We know carve-outs and levels of care by heart. And it is the differences in those that lead to the denials or audits.
We check each and every code according to current AMA CPT and CMS manuals. An outdated code or an incorrect H-code may cause both denials and audits. And the incumbent in the field is still issuing the code that was deleted back in 2021.
An outpatient counselor and program owner require separate services when it comes to billing. We cater to the needs of the counselor’s panel and coding issues. We redirect the program owner to the facility pages dedicated to those tasks. No response is ever general to either of the readers.
Taking your SUD billing in-house is simple and straightforward for you. The process begins with an assessment of your prior claim history – absolutely free of charge. Next, we tie into the systems you are already using, no migration required. Then we bill your claims and deliver monthly reporting that is easy to understand. And there is no locked contract term commitment.
Send us 90 days of SUD claims. We’ll map out miscoding issues, level-of-care denials, and unappealed claims for you, whether you commit or not.
We tie into the system that you’re already using. There’s no data migration involved and no new software to learn. Your staff works as they always have.
We make sure you’re enrolled and that you have SUD benefits verified prior to any claims submission. Your panel issues are flagged early.
Your claims are coded by certified coders and submitted without any errors. Claims are submitted tracked to decisions, with denied claims sorted by reason code.
These reports provide you with the clean claim rate, DSO, and denial reasons. Detailed aging information can be found behind all numbers in the report.
Our Pricing Plans: One percentage of collections. You only pay us after being paid, there is no additional cost of software or set up fee for you to pay. The specific percentage is based upon your volume.
Billing for telehealth services for substance use disorder requires a place of service and modifier 95. Place of service 10 indicates the place as the patient’s residence while 02 indicates another place. Coverage of audio-only is payer-dependent and will determine coverage for rural SUD treatment. Telehealth visits for SUD treatment require the same 42 CFR Part 2 consent.
Telehealth has improved access to SUD treatment and therefore its billing system must evolve. Buprenorphine follow-up through video remains an office E/M visit and the place of service code must indicate the location of the patient. The audio only billing is payer dependent and therefore the phone encounter can be paid on one payer and denied on another. The coders have to set the place of service code and modifier according to the encounter.
SUD billing is the billing process of substance use disorders treatment. It includes detoxification, outpatient counseling, intensive outpatient programs, medication assisted treatment, and recovery support services. All of these services bill separately using their unique codes and rules. The job involves coding, submission of the claim and denial recovery for treatment of the substance use disorder.
Substance abuse billing uses three sets of codes. The ICD-10 F10 to F19 families hold the diagnosis. The HCPCS H-codes including H0001 and H0004 code Medicaid SUD services. The standard CPT codes 90832 to 90838 code the psychotherapy for the dual diagnosis. The SBIRT codes include 99408 and 99409 for screening and brief interventions.
Yes, and MHPAEA assures such coverage. MHPAEA prohibits a plan from limiting substance use disorder coverage more stringently than general medical care coverage. However, the coverage requires medical necessity and often requires authorization based on ASAM level of care. The substance use disorder coverage includes Medicaid, commercial carve-outs, and Medicare.
This is often the case, but it varies based on the license and the payer. LADC, CADC, and CASAC licensure designation differs depending on the state and influences panel access. Medicaid often credentializes SUD counselors, while Medicare added counselors as billing providers in 2024. Each payer defines its own enrollment and taxonomy guidelines.
MAT is billed under an office E/M visit using codes 99202-99215 for office-based buprenorphine. The X-Waiver requirement was discontinued by the Consolidated Appropriations Act of 2023. Now any provider with a DEA registration can prescribe buprenorphine to treat opioid use disorder under the jurisdiction of that state's laws. Medicare reimburses methadone from OTPs through weekly bundles.
Our payment plan involves only one percentage of collections. You pay after you get paid with no lock-in period. Our percentage varies according to how much your collection cycle brings in; our interests will therefore be aligned with yours. The percentage is dependent on your claims activity.
A free read on your substance abuse claims
Send us 90 days of your SUD claims. We show you what was miscoded, denied for level of care, or left unappealed. Call (860) 500-1471 or send the form.
Where are SUD claims costing you?
Simplifying mental health billing with accurate claims, faster reimbursements, and seamless revenue cycle management.
