Substance Use Disorder Billing Specialists
Your SUD Program Deserves Better Than Billing That Works Against You
Addiction treatment providers lose 15-25% of collectible revenue to coding errors, ASAM gaps, and MBHO denials, not from insufficient care, but from a billing environment BehavioralProz was built for.
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Average Net Collection Rate SUD Programs
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Days Average Claim-to-Payment Turnaround
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Years Behavioral Health RCM Experience
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SUD Billing Is Rigged Against Providers
Since the ACA and MHPAEA expanded behavioral health coverage and parity, payers have responded with tighter prior authorization, concurrent review, and audit requirements, not easier access.
Three Code Sets, Zero Margin
UD billing requires fluency in CPT, H-codes, and G-codes that don't map cleanly, and mixing them creates rejection or compliance exposure.
ASAM Documentation Gaps
Payers require explicit ASAM dimension scoring in every submission, and notes that don't justify the level of care get the entire authorization denied.
Hidden MBHO Credentialing Layer
Magellan, Beacon/Carelon, and MHN administer SUD benefits separately, so credentialing with the primary payer doesn't cover their carved-out benefits.
Prior Auth Friction Everywhere
Some contracts require new authorization every 7 days for residential SUD, so a 30-day stay generates four separate approval cycles.
MAT and OTP Complexity
MAT and OTP bills under G2067-G2072 and H0020, with frequently changing rules and standard outpatient codes, cause systematic underpayment.
Parity Violations, Disguised Denials
Many SUD denials are actually parity violations, applying stricter rules than medical admissions, and most practices never recover the loss.
End-to-End SUD Revenue Cycle Management
BehavioralProz manages your full SUD revenue cycle, from pre-admission verification through concurrent review, claims, appeals, and payment posting, so your clinical team stays out of billing.
Pre-Admission Benefits Verification
We verify SUD level-of-care coverage, limits, and the MBHO managing benefits before admission, preventing costly coverage assumptions.
ASAM-Based Prior Authorization
We manage the full auth lifecycle: ASAM-aligned requests, real-time tracking, concurrent reviews, and peer-to-peer escalation on denials.
CPT, H-Code, and G-Code Mapping
We map CPT, H-codes, and G-codes separately to each payer contract, eliminating code-set mismatch denials across your mix.
Denial Management and Appeals
Every denial is resolved through the correct path, corrected claim, clinical appeal, or parity escalation, with trends reported monthly.
MAT and OTP Program Billing
We manage G-code and H0020 billing, medication documentation, and weekly OTP cycles, staying current on CMS and Medicaid updates.
Credentialing and MBHO Enrollment
We credential with commercial, Medicare, Medicaid, MBHO entities, building roadmap so providers are revenue-eligible from day one.
Revenue Reporting and Analytics
Monthly reports cover collections, denials, A/R, authorization use, and parity activity, giving leadership a full operational picture.
Free Revenue Audit for Clients
We run a no-cost audit of denials, write-offs, ASAM compliance, and parity violations to build your custom RCM strategy.
We Know Every SUD Billing Code and When to Use Each
SUD billing requires active mastery of three overlapping code sets, CPT, H-codes, and G-codes, each governed by payer-specific rules for when they apply, how they bundle, and what documentation triggers reimbursement.
| Code | Service Description | Used For |
|---|---|---|
| H0001 | Alcohol and/or drug assessment | Initial SUD assessment under Medicaid and many MBHO-administered commercial plans; the H-code equivalent of 90791 for SUD-specific payers. |
| H0004 | Behavioral health counseling and therapy | Individual SUD counseling sessions under Medicaid and MBHO contracts; used where the payer requires an H-code instead of CPT 90832–90837. |
| H0005 | Alcohol and/or drug services group counseling | Group substance use counseling under Medicaid; equivalent to CPT 90853 but billed using the H-code framework for applicable payers. |
| H0015 | Alcohol and/or drug services, intensive outpatient | IOP-level SUD services under Medicaid; payer-specific unit definitions and daily hour thresholds vary by state Medicaid plan. |
| H0017 | Residential treatment, non-hospital, supervised | Non-hospital residential SUD treatment; used for 30-day and short-term residential billing under Medicaid and some commercial plans. |
| H0020 | Alcohol and/or drug services, methadone administration | Medicaid billing for methadone and MAT services in OTP settings; not interchangeable with Medicare MAT G-codes. |
| G2067 | OTP weekly bundle, patient receiving buprenorphine/naloxone | Medicare weekly OTP bundle for patients receiving buprenorphine products; includes counseling, toxicology, and medication in a bundled payment. |
| G2068 | OTP weekly bundle, patient receiving methadone | Medicare weekly OTP bundle for patients receiving methadone; requires weekly billing with supporting medication and counseling documentation. |
| 99408 | Alcohol and substance abuse structured screening (15–30 min) | SBIRT screening and brief intervention billable in primary care and qualifying outpatient SUD settings. |
| 90791 | Psychiatric diagnostic evaluation | Initial SUD intake evaluation for commercial payers requiring CPT rather than H0001; includes assessment for co-occurring disorders. |
| 90853 | Group psychotherapy | Group therapy billing under commercial payer CPT contracts when the payer does not accept H0005 for group SUD counseling services. |
⚠️ Billing Alert: H0015 is standard for Medicaid IOP billing, but some Beacon and Magellan-administered commercial plans require S9480 instead, and using the wrong code causes systematic, often undetected rejection.
See What's Possible for Your Practice
Onboarded in 5–7 Business Days
Our transition process is designed to protect your cash flow from day one: no billing interruptions, no claim submission gaps, and no lost authorizations during the handoff.
1
Free Revenue Audit
We audit your denial rate, authorization history, A/R aging, and documentation gaps at no cost, showing exactly where revenue leaks.
1
Free Revenue Audit
We audit your denial rate, authorization history, A/R aging, and documentation gaps at no cost, showing exactly where revenue leaks.
1
Free Revenue Audit
We audit your denial rate, authorization history, A/R aging, and documentation gaps at no cost, showing exactly where revenue leaks.
1
Free Revenue Audit
We audit your denial rate, authorization history, A/R aging, and documentation gaps at no cost, showing exactly where revenue leaks.
Trusted by Leading Providers
Dr. Sofia Alvarez
Clinical Director, Residential Addiction Treatment Center
Daniel Ortiz
CFO, Outpatient SUD Treatment Group
Jessica Turner
Program Director, Dual Diagnosis Treatment Facility
FAQ's
1. How does Medicaid SUD billing differ from commercial insurance billing?
+Medicaid SUD billing primarily uses H-codes (H0001, H0004, H0005, H0015, H0017, H0020), while commercial payers generally require CPT codes. However, many MBHO-administered commercial plans also mandate H-codes. Because Medicaid is state-administered, prior authorization rules, code sets, and documentation standards vary significantly by state, requiring separate coding workflows for each payer type.
2. What is the difference between H-codes and CPT codes for SUD billing?
+CPT codes such as 90791, 90853, and 99408 are commonly used for commercial billing, while H-codes are required by many Medicaid and MBHO plans. Although both code sets often describe the same service—for example, H0004 and CPT 90832 cover individual counseling—payers have specific coding requirements. Using the wrong code set can result in repeated claim rejections that often go unnoticed for months.
3. How does utilization review work for SUD residential treatment?
+Utilization review (UR) requires ASAM-based medical necessity documentation at admission and during every concurrent review, which may occur as frequently as every seven days under certain commercial and MBHO contracts. Each review must justify the current level of care, explain why step-down treatment is not appropriate, and include a documented discharge or step-down plan. Mid-stay denials are common and often require immediate peer-to-peer appeals.
4. What is an MHPAEA parity violation, and how do you appeal one?
+Under the Mental Health Parity and Addiction Equity Act (MHPAEA), payers must apply the same utilization management standards to SUD benefits as they do to comparable medical or surgical benefits. A parity violation occurs when SUD services face more restrictive requirements, such as frequent concurrent reviews not imposed on comparable medical admissions. Successful appeals identify the medical comparator, document the disparity, and reference the Department of Labor's Non-Quantitative Treatment Limitation (NQTL) framework.
5. How long does onboarding take, and will there be a gap in billing?
+BehavioralProz typically goes live within 5–7 business days after contract execution without interrupting claim submission. During onboarding, we complete EHR integration, payer portal setup, credential verification, and payer mix documentation before the first claim is filed. Active authorizations are monitored throughout the transition to prevent missed concurrent review deadlines or reimbursement delays.
6. Do you manage prior authorizations and appeals for SUD treatment?
+Yes. BehavioralProz manages the complete authorization lifecycle, including initial requests, concurrent reviews, re-authorizations, peer-to-peer discussions, and payer appeals. Our team also tracks authorization expiration dates, monitors ASAM documentation requirements, and proactively resolves issues before they affect reimbursement.
Ready to Recover the Revenue [Your SUD Program Has Already Earned]?
Request your free revenue audit, and a BehavioralProz SUD billing specialist will review your denial history, coding accuracy, ASAM compliance, and parity exposure, no obligation, just 25 years of expert review.