What Are the Most Used Addiction Treatment CPT Codes in Texas?
Texas is a big state with a big addiction treatment market.
If you’re doing addiction treatment in Texas, you probably already know that just under 8% of Texans use illicit drugs in any given month. The rates of alcohol misuse are even higher. This is a state with a huge demand for addiction treatment and not enough facilities to serve people who need help. It’s also a state that has an outsized draw for those out-of-state looking to get away from bad situations and seek treatment in a sunny and restful climate.
Aside from providing excellent care, one of the most important pieces of running a successful behavioral health treatment center in Texas is negotiating the claims process, minding the cash flow and managing the overall functioning of the revenue cycle.
A key piece of that work: knowing your go-to addiction treatment CPT codes inside and out.
Today, we’ll look at what the most used CPT codes are in Texas for addiction treatment providers.
First, What is a CPT Code Exactly?
CPT codes stand for Current Procedural Terminology. They are codes that are used in medical settings (like behavioral healthcare clinics and addiction treatment centers) to describe services and procedures rendered to patients.
At addiction treatment centers, these codes are used to communicate the type of service offered - like IOP, PHP, outpatient, group counseling, individual counseling, drug testing, etc - to other medical professionals and, most importantly, to insurance companies.
These numerical codes have modifiers at the end in the form of several letters. These modifiers describe the population being served or the context of the services. In addiction treatment, the most common modifier you’ll see is “HF.” HF is used to describe any service that takes place within the context of a substance use program.
Which CPT Codes are Most Likely to be Used at Addiction Treatment Programs in Texas?
The most common CPT codes used in Texas addiction treatment programs also happen to be the most common addiction treatment CPT codes used in the rest of the country. They are: H0001HF, H0004HF, and 96164HF. Codes like H0001HV, H0004HF and 96164HV are also popular in Texas.
The first set of codes refer to services taking place within a private substance use program. The second set of codes describe services taking place at addiction treatment agencies that are at least partially funded by the state.
How the H0001HF CPT Code is Used in Addiction Treatment Programs in Texas
H0001HF describes the billable hours spent completing alcohol and drug assessments for new patients. This code is used for every single patient that enters the doors of any addiction treatment facility in Texas.
Often, this code is required to be accompanied by a taxonomy code on insurance claims forms. A taxonomy code is an alphanumeric code that describes the person completing the assessment by provider type or specialization. Often the H0001HF CPT code is accompanied by the 261QR0405X taxonomy code. This taxonomy code is used for any clinician that specializes in the rehabilitation of SUD.
When to Use the H0004HF CPT Code
Coming in just behind the H0001HF CPT code, we have the H0004HF CPT code. This code is used to describe the hours spent in individual therapy. The “HF” modifier tells us that these hours took place within the context of an addiction treatment program.
Each use of the H0001HF code represents 15 minutes of individual (or “one-on-one”) therapy. If you are trying to bill for an hour of individual therapy, then you would use the H0001HF four times in total.
Why Addiction Treatment Professionals Use the 96164HF CPT Code in Texas
96164HF is the CPT code for group counseling in addiction treatment programs. This is probably the third most used CPT code in Texas addiction treatment centers. This code can only be used in in-person (or face-to-face) counseling sessions, not virtual groups.
You’ll use 96164HF for every 30 minutes spent in a group session. For example, if you’re describing an hour long group counseling session, you’ll record two instances of 96164HF.
Looking for More Information About CPT Codes and Addiction Treatment Billing?
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