Let’s dive into the most common addiction treatment detox HCPCS and CPT codes, what they mean, and when to use them. First, we’ll look at the codes themselves and then answer some questions about HCPCS, CPT, H-Codes, as well as the different types of addiction treatment detox you may encounter with medical billing for behavioral health.
What are the main HCPCS / CPT codes for addiction treatment detox? Answer: H0008, H0009, H0010, H0011, H0012, H0013, H0014
H0008 - Sub-acute Detox, hospital inpatient
H0009 - Acute Detox, hospital inpatient
H0010 - Sub-acute Detox, residential
H0011 - Acute Detox, residential
H0012 - Sub-acute detox, residential program outpatient
H0013 - Acute Detox, residential program outpatient
H0014 - Alcohol and/or Drug services, ambulatory detox
What is the difference between hospital inpatient, residential, ambulatory, and outpatient detox?
Typically when we imagine a detox program, we are imagining a medical detox set up, typically referred to as hospital inpatient detox, either acute or subacute. These programs occur under 24/7 medical supervision of doctors and nurses in a hospital or hospital-like setting. This is the level of care recommended for severe cases of SUD, especially when the patient is a heavy user of alcohol and benzodiazepines, in particular. Withdrawal from these substances can be life-threatening and needs to be handled under medical supervision.
Residential detox occurs at a residential program, which may or may not have an in-house medically managed detox program on-site.
Ambulatory detox - also known as outpatient detox - is used to describe a detoxification process that a patient undertakes at home under the advice and care of a medical professional.
What billing codes are used for addiction treatment detox?
Most substance use billing uses HCPCS Level 1 and Level 2 codes - better known as CPT codes. These codes are five digit strings of numbers and letters that describe various addiction treatment services, such as individual counseling, group counseling, etc. This includes the “H-Codes” that typically describe some of the most common addiction treatment services.
To learn the entire list of CPT codes that pop up in addiction treatment medical billing, review this master list.
What is a HCPCS addiction treatment detox code and when is it used?
HCPCS stands for Healthcare Common Procedure Coding System. It’s created by the Centers for Medicare and Medicaid services and they’re used specifically when coding for Medicare and Medicaid.
HCPCS has two different levels of codes, Level 1 is identical to CPT codes (for more about CPT codes, consult the next section). Level 2 HCPCS codes represent durable medical equipment and non-physician services, like ambulance rides.
What is a CPT addiction treatment detox code and when is it used?
CPT is short of Current Procedural Terminology. CPT codes are managed by the American Medical Association (AMA) and they are used to describe medical goods and services on billing claims. Oftentimes HCPCS codes and CPT codes are the exact same codes. In fact, CPT codes are a kind of HCPCS code.
CPT codes always have a 5 digit long alphanumeric or numeric structure and they consist of 3 categories. Category 1 are the most commonly used codes, and they consist entirely of numbers. Category 2 codes represent “add-on” services that aren’t adequately described by Category 1 codes. This includes the so-called “H-Codes” for rehabilitative services or addiction treatment services. Category 3 codes represent temporary and experimental services. Category 3 codes are rarely used in addiction treatment billing.
What is the difference between HCPCS codes and CPT codes?
HCPCS codes include CPT codes.
HCPCS codes are specifically used only for Medicare and Medicaid claims.
CPT codes are used for all types of claims - both public and private payer billing.
When a CPT code is used in a Medicare or Medicaid claim, it’s technically a HCPCS Level 1 claim. However, in this situation, the HCPCS/CPT code is, for all intents and purposes, the same string of 5 letters and/or numbers.
What are H-Codes in Addiction Treatment Detox Billing?
H-codes are simply CPT/HCPCS codes that begin with the letter H. They are a group of codes that specifically refer to drug and alcohol treatment, addiction treatment or behavioral health services that only happen in addiction treatment settings. This is in contrast to group counseling, for example, which can happen in many different clinical settings. The CPT code for group counseling - 96164 - isn’t a part of the H-code set of CPT codes for this reason.
Other Blog Posts About CPT Codes, Addiction Treatment Billing, and ICD Codes
Here’s How to Fix Your Substance Abuse Billing Issues
Dive Into the Top 3 CPT Codes for Addiction Treatment: H0001HF, H0004HF, and 96164HF
The Ultimate Addiction Treatment Medical Billing Glossary
What You Need to Know About ICD-10 Codes for Addiction Treatment Billing
How to Get the Top 10 Insurance Companies to Cover Care for Your Patients
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