CPT Codes For Addiction Treatment
Due to the ongoing addiction crisis in the United States, the need for treatment has grown significantly. For those clinics and treatment centers that are at the forefront of this medical emergency, proper implementation of CPT codes for addiction treatment is essential.
Coding & Billing Solutions has deep expertise in addiction treatment coding and compliance and has clients like New Life Medical Addiction Services, which has turned over all of its medical coding and billing to the CBS Team. “Sheri and her coding team have become an indispensable part of the extended New Life Team. Not only have they streamlined our medical coding, they have provided us with valuable insights and coding tips that have allowed us to claim more revenue from the services we provide while also facilitating a better patient experience and outcome” said Dr. Joseph Savon, Chief Medical Officer and Co-Founder of New Life.
The CBS Team is constantly reviewing the latest standards for medical coding for substance abuse treatment. In this post we will review 3 of the most used CPT codes for addiction treatment and how they should be implemented in your treatment center’s coding and billing operation.
Modifiers for Addiction Treatment Billing CPT Codes
In CPT codes for addiction treatment, most of the base code is the same, but it is the alpha modifiers that facilitate proper detailed coding.
The following are some of the most common CPT code modifiers for addiction treatment billing:
HA: For programs dealing with children under 18
HB: For programs dealing with adults younger than geriatric age.
HD: Used for programs designed for pregnant and parenting women.
HF: Substance use programs
HV: Used for addiction services that are funded by the state.
TG: Designates programs that deliver a complex and/or high level of care.
The Following Is An Overview Of The CPT Codes For Addiction Treatment
Addiction Treatment Billing CPT Code – H0001HF
H0001HF is a CPT code that refers to drug and alcohol assessments for SUD (Substance Use Disorder) treatment.
The CPT code for this is “H0001” and the modifier for this is “HF.” H0001 refers to time that counselors, doctors, and other clinicians spend performing alcohol and drug assessments with clients in the course of treatment for SUDs. The HF modifier is the indication that the billable hours are taking place in the context of a substance use program.
This code is used when conducting assessments with clients to determine the presence and severity of SUD in the course of creating and updating their treatment plans at an addiction treatment facility.
Addiction Treatment Billing CPT Code – H0004HF
H0004HF is a CPT code that refers to individual therapy/one-on-one counseling in an addiction treatment environment.
The CPT code for this is “H0004” and the modifier for this is “HF.” H0004 describes time spent doing individual counseling with a client and the inclusion of the modifier, HF, indicates that these billable hours have occurrent within the context of a substance use program. Please note that this code can only be used for sessions with an individual patient and not for sessions involving the patient’s friends or family,
Each instance of this code corresponds to 15 minutes of service. Accordingly, if sessions are one hour long, this code needs to be submitted four times to account for the four 15-minute blocks of individual therapy that occurred on that day.
Addiction Treatment Billing CPT Code – 96164HF
96164HF is a CPT code for group counseling done in a face-to-face setting in an addiction treatment program.
The CPT code is “96164” and the modifier is “HF.” The CPT code, 96164, represents face-to-face (in-person) group counseling and the HF modifier is used to communicate that the service took place in a substance use program. This code is used to describe the first 30 minutes of any behavioral health group session.
When billing for any of these CPT codes, it’s often recommended to provide a taxonomy code that describes the facility by provider type and/or specialization. The taxonomy code that is most often used for this is 261QR0405X which describes a provider that specializes in addressing substance use disorders.
CBS Has Addiction Treatment Expertise
Are you a substance abuse or addiction treatment facility and you would like to discuss how Coding & Billing Solutions can help you with medical coding and compliance, contact us today!