Coding for addiction treatment is remarkably simple as long as you understand the basics.
In this post, we’ll break down the most frequently used codes for residential addiction treatment programs. We’ll examine the similarities and differences between them as well as common pitfalls to avoid when selecting which billing code to use on an insurance claim.
What Are Residential Addiction Treatment Programs and How Does Billing for These Programs Differ From Hospital-Based Programs?
Before we get started, let’s get our terminology sorted.
Residential addiction treatment programs are “live-in” behavioral health programs designed to treat patients who temporarily live on-site at the facility.
Hospital-based programs may technically have behavioral health patients living on-site in hospital beds for a set period of time depending on the patient’s needs, but they are not considered residential programs. Residential programs generally resemble basic homes more than hospitals. They are not typically staffed by medical personnel 24/7, nor do they typically handle medical detox or other higher levels of care. Residential programs are generally for medically stable patients who simply require behavioral healthcare, rather than close medical supervision.
Billing Code H0017: Behavioral Health - Residential Without Room and Board
What is H0017 and what does it represent?
Use H0017 when you are describing a single day’s worth of clinical services at a residential addiction treatment or behavioral health facility. H0017 may not be used to describe room and board charges, as those are not covered by H0017 claims.
H0017 belongs to a set of billing codes known as “H-Codes,” which is a reference to the H preceding the next 4 numbers in the alphanumeric code. H-Codes always describe behavioral healthcare services that do not overlap with other types of services that occur outside behavioral healthcare, like general group counseling. H-code services are unique to addiction treatment and behavioral healthcare.
H0017 is an HCPCS code as well as a CPT code, meaning it can be used for both private and public insurance billing purposes.
How Often Should I Use H0017 on a Claim?
H0017 is used on a “per diem” basis, meaning you submit a single claim for each day of service as described by the code. In other words, H0017 represents a single day of residential addiction treatment, minus the room and board fees. Therefore, you submit a claim for H0017 on a daily basis.
Billing Code H0018: Behavioral Health - Short-Term Residential Without Room and Board
What is H0018 and what does it mean in behavioral health billing?
H0018, unlike H0017, is for short-term residential behavioral healthcare services. For the purposes of H0018, all services must be truly residential (as opposed to hospital-based or outpatient).
The definition of short-term residential addiction treatment is typically anything less than a 30-day program, including 28 day long programs.
Like H0017, it too is an H-Code belonging to both the CPT and HCPCS families of medical billing codes.
Furthermore, H0018 may only be used to bill for clinical services. Room and board charges are not covered or described by H0018 claims.
Billing Code H0019: Behavioral Health - Long-Term Residential Without Room and Board
What is H0019 and when is it used in behavioral health billing?
H0019 is the final residential addiction treatment billing code we’ll discuss in this post.
H0019 describes long-term residential treatment programs for addiction treatment.
Like H0017 and H0018, it is an “H-Code” as well as a CPT and HCPCS code. Because of this versatility, H0019 may be used for both private and public payer claims in the same way that H0017 and H0018 can.
Long-term residential addiction treatment programs are defined as any program that lasts longer than 30 days. Some long-term programs last 60, 90 or even 120 days, depending on the severity of the patient’s SUD symptoms and the complexities of any co-occurring disorders.
Like H0017 and H0018, H0019 only describes residential programs, not hospital-based programs or other acute care settings. While patients may “live” at programs representing a higher level of care than strictly “residential” programs, hospital-based programs are described by other billing codes.
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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