At Behave Health, we love CPT codes for addiction treatment!
CPT codes might not be the most exciting topic in the world but, get them wrong, and billing insurance for your addiction treatment services isn’t possible. That’s why it’s important to learn everything you can about addiction treatment CPT codes (or hire a billing service that specializes in addiction treatment) to get CPT codes right the first time, every time and keep your revenue cycle running smoothly.
Today, we will look at the top 3 most used addiction treatment CPT codes across the country and break down how - and when - to use them in your addiction treatment center’s billing process.
First, a Word About CPT Code Modifiers for Addiction Treatment Billing
If you don’t see your most-used codes on this list, it’s probably because your addiction treatment center serves a specialized population, like children or pregnant and parenting women. You’ll see that for your CPT codes, most of the code is the same, except for the last few letters on the code, called a “modifier.”
Here’s a few of the most common CPT code modifiers you’ll see in addiction treatment billing.
HA: Used for programs dealing with children under 18
HB: Used for programs dealing with adults (but not geriatric adults)
HD: Designates programs designed for pregnant and parenting women
HF: Substance use programs
HV: Used for addiction agencies that are funded by the state
TG: Designates programs that deliver a complex and/or high level of care
Addiction Treatment Billing CPT Code #1: H0001HF
The CPT code for this is “H0001” and the modifier for this is “HF.” H0001 refers to time spent completing drug and/or alcohol assessments with clients in the course of treatment for substance use disorder. The HF modifier simply indicates that the billable hours are taking place in the context of a substance use program.
You’ll use this code when conducting assessments with clients to determine the presence and severity of substance use disorder in the course of developing and updating treatment plans at your addiction treatment facility.
When you are billing for this CPT code, it’s likely that you’ll also provide a taxonomy code that describes your facility by provider type and/or specialization. The taxonomy code you’ll most likely see associated with this CPT is 261QR0405X. This taxonomy code describes a provider that specializes in the rehabilitation of substance use disorders.
Addiction Treatment Billing CPT Code #2: H0004HF
The CPT code for this is “H0004” and the modifier for this is “HF.” H0004 describes time spent doing individual therapy with your client. The inclusion of the modifier, HF, indicates that these billable hours have taken place in the context of a substance use program.
You’ll use this code when you’re doing one-on-one counseling with your clients at your addiction treatment facility. Note that you cannot use this code for sessions involving family or friends of your client, only for individual sessions.
Each instance of this code describes 15 minutes of service. So, if sessions are one hour long, you’ll submit this code four times to account for the four 15-minute blocks of individual therapy that occurred on that day.
You’ll probably also use the same taxonomy code that you used for CPT code H0001HF, which is 261QR0405X. Again, this code describes your organization by provider type. In this case, you’re an addiction treatment center, so you’ll choose the taxonomy code 261QR0405X to identify your organization as a rehab facility for those suffering from substance use disorder.
Addiction Treatment Billing CPT Code #3: 96164HF
The CPT code here is “96164” and the modifier being used is, again, “HF.” The CPT code, 96164, represents face-to-face (in-person) group counseling. The modifier, HF, is used to explain that the service took place in a substance use program.
You’ll use this code when you are doing group sessions with clients. This code is used to describe the first 30 minutes of any behavioral health group session.
When you use this code, you’ll likely also use the same taxonomy code mentioned in the first two CPT codes in the post: 261QR0405X. Again, this taxonomy code communicates who your organization is as a provider. You’re a facility that specializes in the rehabilitation of those with substance use disorder and 261QR0405X expresses that fact in your claim.
If You’re Struggling with CPT Codes for Addiction Treatment, We Can Help
CPT codes are confusing and they are prone to change. If you’re frustrated about working with CPT codes, you’re not alone.
At Behave Health, we simplify the billing process for addiction treatment providers and get you the reimbursements you deserve, quickly and painlessly. Our billing professionals have close relationships with all the major insurance companies in the nation, and we know the ins and outs of how billing works at each of the big players. We’re seasoned experts in submitting claims that stick.
Get your free trial started today and see why more addiction treatment centers prefer Behave Health.