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Medicaid Billing Secrets for Addiction Treatment in Tennessee

What is Medicaid Called in Tennessee and what Department is Responsible for Addiction Treatment in the State?

Medicaid in Tennessee is called TennCare. According to a recent study, well over 65% of all addiction treatment centers in Tennessee accept Medicaid. That number is growing about .1% every year, with a total of 297 facilities treating SUD in Tennessee.   

In Tennessee, some mental health and substance abuse services are separated out from TennCare under the umbrella of  the Behavioral Health Safety Net. BHSN serves over 32,000 people with community-based behavioral health support a year. There are 153 BHSN locations throughout Tennessee. 

Tennessee’s Department of Mental Health and Substance Abuse Services (TDMHSAS) oversees all addiction treatment services in the state, from residential to intensive outpatient.

Tenncare operates within a network of Managed Care Organizations. The main MCOs in Tennessee that administer Medicaid benefits are Wellpoint, BlueCare and UnitedHealthcare.

What Addiction Treatment Services are Covered in Tennessee Under TennCare?

TennCare services include:

  • Inpatient treatment 

  • Residential treatment 

  • Outpatient treatment 

TennCare also provides free addiction treatment services for uninsured individuals, under a program called BHSN. It is not affiliated with Medicaid. According to the BHSN Provider Manual, BHSN services include:

  • Assessment and evaluation

  • psychological testing evaluation services

  • individual therapy

  • group therapy

  • psychosocial rehabilitation

  • peer support

  • case management

  • transportation 

  • psychiatric medication management 

  • administration of long acting injectables

  • labs related to medication management

What are the Most Commonly Used Medicaid CPT Codes for Addiction Treatment in Tennessee for TennCare? 

Some of the most commonly used CPT codes for addiction treatment delivered via Medicaid to patients in Tennessee include:

  • Naltrexone, initial visit codes, 99201 – 99205

  • Naltrexone, subsequent visit codes, 99211 – 99215  

  • Suboxone/buprenorphine – Comprehensive Medication services, (Subsequent visit)  - H2010

  • Suboxone/buprenorphine – Comprehensive Medication services, (Initial visit)  - H2010U1

  • Naltrexone initial visit codes 99201 - 99205 

  • Naltrexone subsequent visit codes 99211 - 99215

  • Psychiatric diagnostic evaluation (with no medical services) - 90791 

  • Psychiatric diagnostic evaluation (with medical services) - 90792 

  • Psychological testing evaluation service - 96130 

  • Psychotherapy, 60 minutes - 90837 

  • Psychotherapy, 45 minutes - 90834 

  • Psychotherapy, 30 minutes - 90832

  • Family/couple psychotherapy - 90847

  • Group psychotherapy - 90853

  • Drug screen with brief intervention (SBI) services, 15 - 30 minutes - 99408

  • Drug screen with brief intervention (SBO) services, 30 minutes - 99409

  • Drug screen only - H0049

  • Alcohol and/or drug abuse services, all-inclusive case rate, H0047

  • Individual psychosocial rehabilitation - H2017

  • Group psychosocial rehabilitation session - H2017HQ

  • Individual peer support session, 15 minutes, maxim of 4 per person on a single day - H0038

  • Group peer support session, 15 minutes, maximum of 24 units per person within a single day - H0038HQ

  • Case management - T1016

  • Non-emergency transportation, per diem - T2002

  • Non-emergency transportation, encounter/trip - T2003

  • Non-emergency transport bus - A0110

  • Psychiatric medication management: Office or outpatient evaluation and management - 99211

  • Psychiatric medication management: requiring history and/or examination, 10-19 mins - 99212

  • Psychiatric Medication management: requiring history and/or examination, 20-29 mins - 99213

  • Psychiatric Medication management: requiring history and/or examination, 30-29 minutes - 99214

  • Psychiatric medication management: requiring history and/or examination, 40-54 minutes - 99215

  • Mediation training and support, 15 minutes - H0034

  • Long acting injectable, therapeutic - 96372

  • Family support sessions with a CFSS, 15 minutes, maximum 8 per person or family on a single day of service - H2014

How is Eligibility Determined for Addiction Treatment Medicaid Services in Tennessee?

Eligibility for TennCare is determined by being a resident of the state of Tennessee, being over 18, and living at or below 138% of the federal poverty level, In 2024, this means that a single individual must make less than $20,783 a year to qualify for Medicaid in Tennessee. A family of four would need to make less than $43,056 per year.

Does Tennessee TennCare Cover Peer Support Services for Medicaid Patients?

Yes. According to Tennessee’s Peer Recovery Support Specialist Handbook, Medicaid reimburses for peer support services in the state. In order to be covered under Tenncare, all peer support must be delivered by a Certified Peer Recovery Specialist who is employed by an organization that is licensed by the Tennessee Department of Mental Health and Substance Abuse Services and they must also been under the supervision of a behavioral health professional. 

When billing Tennessee Medicaid for peer support services, the relevant CPT codes are: H0038, which represents 15 minutes of individual peer support, and H0038HQ, which represents 15 minutes of group peer support. There are restrictions placed on each code: H008 may only be billed four times per person, per day, while H008HQ can only be billed 24 times per person per day.

Does Tennessee Medicaid Cover Sober Living Homes? 

No. Sober living homes are not covered under Medicaid programs in Tennessee. They are rarely covered under state Medicaid programs. 

More Information About Behavioral Health Billing, Medicaid, and Business in Tennessee

What Reviews are Required for Addiction Treatment Providers Under Blue Cross Blue Shield of Tennessee?

Here’s What it Takes to Open an Addiction Treatment Center in Tennessee

5 Things Every Tennessee Sober Living Home Business Startup Should Know

Behave Health Sets Addiction Treatment in Tennessee Up for Success

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Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!