Addiction Medicine Billing Services Built on MAT, Counseling, and Every Documented Visit

Addiction medicine billing includes the complete revenue cycle for substance use disorder treatment, covering opioid use disorder and buprenorphine management, alcohol use and naltrexone management, SBIRT screening, SUD counseling, crisis and overdose visits, detox and withdrawal management, co-occurring behavioral health, and telehealth SUD. It spans eligibility verification, MAT prior authorization, counseling time documentation, coding, claim submission, payment posting, denial management, A/R follow-up, and reporting. We handle the full range an addiction medicine program delivers.

Medication-assisted treatment is billed as the office E/M, with the SUD counseling reported by documented time and modifier 25 appended when a separately identifiable E/M is delivered the same day. Buprenorphine is most often a pharmacy benefit, so the medical claim and the pharmacy dispense are coordinated, and the induction, dosing, and counseling are documented to support both. Naltrexone, where administered in the office, is billed under its HCPCS J-code with prior authorization where required.

In many cases, yes. Buprenorphine and extended-release naltrexone frequently require prior authorization, and the medication line denies when the authorization is not on file before the visit or injection. We obtain the prior authorization before the visit, and we verify the approved medication, the dose, and the frequency against the plan, so the claim is not performed against an approval that does not match the medication billed.

The SUD counseling codes are selected by documented time. 99408 is approximately 30 minutes and 99409 is approximately 45 minutes, with the start and stop times recorded to the minute. We document medical necessity and select the code by the documented minutes, and we append modifier 25 when a separately identifiable E/M is delivered the same day. Without the documented times, the counseling downcodes or denies.

SBIRT is Screening, Brief Intervention, and Referral to Treatment. The screening is billed by the documented minutes, with G0396 for a 5 to 10 minute screen and G0397 for an 11 to 15 minute screen, where covered. We verify the current HCPCS code and time tier against the payer policy, and we track the screening frequency so the code is billed within the covered limit. The brief intervention is reported with the SUD counseling code where delivered.

Yes, where the payer and the state permit it. The place of service is set to where the patient is located, with POS 02 or POS 10 and the telehealth modifier such as 95 appended. Home induction is allowed where the payer and state permit, and it is documented in the record. We verify the telehealth modifier, the place of service, and the home-induction rules against the current payer and state policy before submission, since SUD telehealth rules change frequently.

When a substance use disorder and a mental health condition are both treated, both diagnoses are coded, with the SUD such as F11.20 and the co-occurring condition such as F90.2 documented together. We code both the primary and the secondary diagnosis so the claim reflects the full service delivered, and we coordinate with behavioral health where the care spans both. Dropping the secondary diagnosis under-supports the work and reduces the documented medical necessity.

Withdrawal management is billed by the level of care, with the facility and professional codes supported by the documented level of care and the counseling time. Inpatient withdrawal management is reported under H0000 where covered, and the SUD counseling is reported separately where delivered. We document the level of care, the medical necessity, and the counseling times, so the facility and the professional components are both supported.

Yes. Substance use disorder billing is subject to SAMHSA and state-specific rules that the payer enforces, including telehealth induction, counseling frequency, and documentation requirements. We track the SAMHSA and state SUD rules that apply to the program and build them into the claim, so the submission meets the state and payer requirements. Where the rules differ by state, we apply the rule that governs the patient location.