Addiction Medicine Billing Services

Addiction medicine billing is a patchwork. There are no addiction-specific CPT codes for office-based treatment, so the same visit may be coded with evaluation and management codes, psychotherapy codes, or Medicaid H-codes depending on the payer and the setting. Higher levels of care add prior authorization and concurrent review, and telehealth rules differ between Medicare and commercial plans. A practice that bills every addiction encounter the same way will see denials that have nothing to do with the care delivered.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for addiction medicine practices, built around the specialty’s actual code families and payer requirements.

Addiction Medicine billing challenges

Office-based treatment of opioid use disorder is billed with standard professional codes. Evaluation and management visits use the office visit codes, and counseling is billed with psychotherapy codes such as 90832, 90834, and 90837 for individual sessions and 90853 for group sessions. Because there is no dedicated addiction CPT family, the level of service must be supported by documented time or medical decision making, and the note must support the code selected.
Medicaid substance use disorder programs commonly use HCPCS H-codes instead of CPT codes, including H0004 for individual counseling, H0005 for group counseling, H0015 for intensive outpatient treatment, and H0018 and H0019 for short-term and long-term residential treatment. Unit rules for these codes vary by state Medicaid program, and many are billed in 15-minute units, so unit counts must follow the specific program’s rules rather than a national default. Medicare covers opioid use disorder treatment with monthly codes G2086 for the first month, G2087 for subsequent months, and G2088 for additional time, which follow a different structure from visit-based billing.
Prior authorization is the most common preventable denial source in this specialty. Higher-intensity services, including inpatient care, residential treatment, partial hospitalization, and intensive outpatient programs, almost always require authorization before admission and concurrent review to continue. Documentation of symptoms, functional impairment, risk factors, and treatment response is what supports the level of care billed. Telehealth adds another variable: Medicare removed geographic and originating site restrictions for substance use disorder telehealth, but commercial payer telehealth rules still vary and must be checked per plan.

What MedPlus RCM handles for Addiction Medicine practices

• End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
• Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
• Provider credentialing and enrollment. End-to-end enrollment with commercial payers, Medicaid programs, and Medicare, plus re-credentialing maintenance.
• Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
• A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
• Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
  We serve addiction medicine practices nationwide, including office-based treatment programs, intensive outpatient programs, and practices offering medication-assisted treatment.

Results Addiction Medicine practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Are there CPT codes made specifically for addiction treatment?
No. Office-based addiction treatment is billed with standard evaluation and management and psychotherapy codes. Medicaid programs often use H-codes instead, and Medicare uses monthly codes for opioid use disorder treatment.
How is intensive outpatient treatment billed?
Intensive outpatient programs are commonly billed with H0015 in Medicaid programs, while commercial payers may use revenue codes or per diem structures that vary by contract. Authorization and concurrent review are usually required.
Do you handle telehealth for substance use disorder treatment?
Yes. Medicare telehealth rules for substance use disorder treatment no longer include the geographic and originating site restrictions that apply to some other telehealth services, but commercial payer rules vary and are verified per plan.
Why do residential and higher levels of care deny so often?
The most common cause is missing or expired prior authorization, followed by documentation that does not support the level of care billed. Symptoms, functional impairment, and treatment response must be documented to justify the level.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your addiction medicine practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
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