Addiction treatment billing
Level of care, authorization and Part 2 consent checked before every SUD claim.
We bill substance use disorder programs the way payers review them: each day matched to an approved level of care, the right H-code or revenue code for each payer, Medicare OTP and IOP claims billed to CMS rules, and Part 2 consent on file first.
- Full-service rate
- 3% to 6% of collections
- Programs
- Outpatient, IOP, PHP, OTP
- Medicare
- OTP bundles and IOP since 2024
- New & smaller practices
- Flexible monthly minimum
What makes addiction treatment billing different
An SUD program bills a level of care, not just a visit. The payer approves a level, such as intensive outpatient, for a number of days, then reviews the case before approving more. The code for the same service changes by payer and state, and the records carry their own federal confidentiality rules.
We set up each payer’s codes and reviews before the first admission and check every claim against its authorization, as part of our full revenue cycle service at 3% to 6% of collections.
ASAM levels of care, as payers use them
ASAM Criteria, fourth edition. Many payers still use third-edition labels, so we bill to each payer’s list.
- Level 1: Outpatient1.0 long-term remission monitoring, 1.5 outpatient therapy, 1.7 medically managed outpatient.
- Level 2: Intensive outpatient2.1 intensive outpatient, 2.5 high-intensity outpatient, 2.7 medically managed intensive outpatient.
- Level 3: Residential3.1 clinically managed low-intensity, 3.5 clinically managed high-intensity, 3.7 medically managed residential.
- Level 4: InpatientMedically managed inpatient care.
- Third-edition labelsStill common: Virginia Medicaid bills 2.5 as partial hospitalization and keeps a 3.3 residential level.
Medicare: the OTP bundle and intensive outpatient
Medicare pays opioid treatment programs a weekly bundle. Under CMS’s OTP billing rules, the bundles are G2067 (methadone), G2068 (oral buprenorphine), G2069 and G0533 (monthly and weekly injectable buprenorphine), G2073 (naltrexone), G2074 (no drug that week) and G2075 (another medication). Add-ons include intake (G2076), periodic assessment (G2077), take-home doses (G2078, G2079), extra counseling (G2080), naloxone, and care coordination, navigation and peer support (G0534 to G0536).
Professional claims use place of service 58, and every OTP claim carries an opioid use disorder diagnosis. For 2026, CMS updated the bundle rates, with the non-drug part up 2.7%, and rewrote intake (G2076) around a standardized, evidence-based assessment instead of the 2025 social determinants of health risk assessment.
Medicare’s intensive outpatient benefit began January 1, 2024 and covers substance use disorders. Hospital outpatient departments, critical access hospitals, community mental health centers (CMHCs), rural health clinics, FQHCs and, for opioid use disorder, OTPs can furnish it. Hospitals and CMHCs report condition code 92 and are paid per day. A physician certifies the need for IOP, the plan of care must show at least 9 hours of services a week, and an OTP bills IOP as add-on G0137 only in a week with at least 9 IOP services.
Medicaid and commercial claims: H-codes and revenue codes
Medicaid and many commercial plans pay SUD services on HCPCS H-codes, and each state or plan decides how they are used. South Dakota’s SUD service code list for fiscal 2027 bills H0001 (alcohol and/or drug assessment), H0004 (counseling) and H0005 (group counseling) in 15-minute units, H0020 (methadone administration) per day, and H2036 as behavioral health day treatment, per day.
Virginia Medicaid ties codes to ASAM levels: H0015 with revenue code 0906 for 2.1 intensive outpatient, S0201 with revenue code 0913 for 2.5 partial hospitalization, H2036 with revenue code 1002 for 3.7 residential, and H0020 for OTP medication. So H2036 is day treatment in one state and residential care in another.
Facility claims also need the right revenue code, such as 0906 for chemical dependency intensive outpatient under Medicare’s IOP rules. We build each payer’s code map before the first claim.
42 CFR Part 2 and sharing records for claims
SUD treatment records from programs that are federally conducted, regulated or assisted fall under 42 CFR Part 2. Under the 2024 final rule, with compliance required by February 16, 2026, a patient can sign one consent for all future uses and disclosures for treatment, payment and health care operations. A HIPAA covered entity or business associate that receives records under that consent can redisclose them as HIPAA allows.
The rule also applies HIPAA breach notification and penalties to Part 2 records and says programs do not have to segregate them. For billing, a signed consent covering payment should be on file before claims, records or authorization requests go to a payer. We check for it at intake.
Prior authorization, concurrent review and parity
Plans manage SUD care with prior authorization at admission and concurrent reviews during treatment. Our prior authorization service sends the assessment, treatment plan and progress notes on each plan’s schedule and tracks approved days against the claims.
Under the federal parity law (MHPAEA), the Labor Department’s September 2026 enforcement bulletin says medical necessity processes for mental health and SUD benefits must be comparable to, and applied no more stringently than, those for medical and surgical benefits, and that plans must give participants their medical necessity criteria on request. It names prior authorization, concurrent and retrospective review as focus areas. We ask for the criteria when a denial cites them.
Why SUD claims deny
Common reasons:
- No authorization for the level of care or the dates billed
- Days past what the last concurrent review approved
- A level of care the program’s license or contract does not cover
- A code, revenue code or modifier the state or plan does not use for that level
- Program or clinician not enrolled with the payer on the date of service
- A Medicare OTP claim without an opioid use disorder diagnosis
Our eligibility and benefits checks confirm who manages the SUD benefit and its authorization rules before admission, and our denial code guides explain each reason code.
How we run addiction treatment billing
Map each payer’s codes
Levels of care, H-codes, revenue codes, modifiers and review steps are set up for every payer.
Verify and authorize
Benefits, the benefit manager and the first authorization are confirmed before admission, with Part 2 consent on file.
Track every review
Approved days, next review dates and level changes are tracked per patient.
Check every claim
Level, code, units, rendering clinician and diagnosis are checked against the authorization and the note.
Report monthly
Collections, days in A/R, denials by reason and reviews coming due, by payer and by level of care.
Credentialing for the program and its clinicians
An SUD program is credentialed twice: as a program, and clinician by clinician. The program needs a state license for each level it offers, then Medicaid enrollment and each plan’s contract. An OTP must also be certified by SAMHSA, accredited by a SAMHSA-approved body, licensed by the state and registered with the DEA, according to SAMHSA’s OTP guidance. Provisional certification lasts up to one year and is not granted without state and DEA approval.
Prescribers and counselors are then enrolled on their own licenses; how counselors, including addiction counselors, enroll with Medicare is on our mental health credentialing page.
Addiction treatment billing questions
Something else? Call +1 786-788-7313. A biller answers.
All questionsH0015 is an alcohol and/or drug services code, and each state or plan sets how it is used. Virginia Medicaid bills it with revenue code 0906 for ASAM level 2.1 intensive outpatient, while South Dakota uses it for low-intensity residential and intensive meth treatment, in 15-minute units. We bill it to each payer’s own fee schedule.
Yes, since January 1, 2024, for substance use disorders as well as mental health conditions. Hospital outpatient departments, CMHCs, rural health clinics, FQHCs and, for opioid use disorder, OTPs can furnish it. A physician certifies the need for IOP, the plan of care must show at least 9 hours of services a week, and OTPs bill it as add-on G0137.
A 7-day episode of care with a drug component, a non-drug component or both. The bundle covers dispensing or administering the drug, substance use counseling, individual and group therapy and toxicology testing if performed. Intake, assessments, take-home supplies, extra counseling and naloxone are billed as add-on codes. A week with no medication is G2074.
If your program is covered by 42 CFR Part 2, yes. Under the 2024 final rule, with compliance due by February 16, 2026, a patient can sign one consent for all future uses and disclosures for treatment, payment and health care operations. If you are unsure whether Part 2 applies, check with your health care attorney.
Some do, but many payers and state manuals still use third-edition labels. In the fourth edition, 2.5 is high-intensity outpatient; Virginia Medicaid still bills it as partial hospitalization, and still bills a 3.3 residential level the fourth edition does not have. We bill to each payer’s own labels.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus review tracking. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How to calculate days in A/R
The formula with a worked example and a calculator, the benchmarks, why a good average can hide old claims, and the fixes that bring days in A/R down.
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Send us your last 90 days of SUD claims.
We’ll review them free and show you where authorizations, level-of-care codes or Part 2 consents are costing you money.