Substance Abuse and Addiction Medicine Billing Services
Addiction treatment billing covers a wide range of settings, from an office that prescribes medication to a program with counseling groups and drug testing. Each setting has its own payers and rules. Medicaid carries a large share of care in many states, and state programs often have their own codes and requirements.
Drug testing adds another layer. Payers limit how often tests can be billed and how deeply a lab can test. Privacy rules for substance use records can also affect how information is shared. Westmont Revenue Partners connects addiction medicine providers with vetted medical billing experts who know these rules. This page outlines the common services and where addiction medicine billing runs into trouble.
Who this is for
- Addiction medicine physicians and psychiatrists
- Office-based opioid treatment and buprenorphine prescribers
- Outpatient substance use treatment programs
- Opioid treatment programs
- Practices that provide counseling and group therapy
What gets billed
- Screening and brief intervention for alcohol and drug use
- Assessments and intake evaluations
- Office visits for medication treatment
- Medication-assisted treatment
- Extended-release injectable medication administration
- Individual, family and group counseling
- Urine and other drug testing
- Care coordination and case management
- Telehealth visits
- Intensive outpatient services where offered
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99408 | CPT | Alcohol and substance screening with brief intervention, 15 to 30 minutes |
| 99409 | CPT | Alcohol and substance screening with brief intervention, over 30 minutes |
| G0396 | HCPCS | Medicare alcohol and drug assessment and brief intervention, 15 to 30 minutes |
| G0397 | HCPCS | Medicare alcohol and drug assessment and brief intervention, over 30 minutes |
| 80305 | CPT | Presumptive drug test read by direct optical observation |
| 80307 | CPT | Presumptive drug test run on an instrument chemistry analyzer |
| 99214 | CPT | Established patient visit, moderate complexity |
| 90834 | CPT | Psychotherapy, about 45 minutes |
| 90853 | CPT | Group psychotherapy |
| F11.20 | ICD-10-CM | Opioid dependence, uncomplicated |
| F10.20 | ICD-10-CM | Alcohol dependence, uncomplicated |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in addiction medicine
- Drug testing limits. Payers cap how often tests can be billed and which kinds. Billers match testing orders to medical necessity and policy.
- Medicaid state variation. States use different codes, modifiers and rates for treatment services. Billers keep state manuals close and update setups yearly.
- Opioid treatment program billing. Programs use bundled weekly payments with their own rules. Billers learn the payer structure for each program type.
- Screening code choice. Commercial and Medicare plans may use different screening codes. Billers confirm which one each plan expects.
- Substance use record privacy. Federal rules protect these records more strictly than other health data. Billers follow the program's consent and disclosure process.
- Prior authorization. Some plans require approval for higher levels of care or specific drugs. Staff track requirements and renewals.
- Combined medical and behavioral services. A visit may include prescribing and counseling. Billers separate time and service so both are billed correctly.
How Westmont can help
- Match you with vetted billing experts experienced in addiction medicine
- End-to-end revenue cycle support, including testing and counseling claims
- Denial management and appeals
- Credentialing and payer enrollment
- Help organizing billing across different service lines
Frequently asked questions
How is urine drug testing billed?
Testing is usually split into a first-line presumptive test and, sometimes, a more detailed definitive test. Payers set limits on frequency and type. Document why each test was ordered and check each payer's current policy.
Can I bill counseling and a medication visit on the same day?
Often yes, if each service is separate and documented. The time and content for each should be clear. Check payer rules for same-day billing.
What is different about Medicaid billing for addiction treatment?
Each state sets covered services, codes and provider types. Many have unique rules for treatment programs. Review your state manual and each managed care plan's guidance.
Are substance use records handled differently?
Yes. Federal rules give them added privacy protection. Billing partners need to follow your consent process and share only what is allowed.
Do opioid treatment programs bill like other clinics?
Not usually. They often use bundled payments and program-specific rules. Ask a billing partner about experience with your payer type.
Related billing services
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