The good news: CPT codes for addiction treatment billing have not changed much in 2024!
The bad news: There are still a few tricks and tips that savvy addiction treatment billers and coders will want to keep in mind for 2024.
In this post, we’ll cover some of the basics of the 2024 changes to CPT and HCPCS codes for addiction treatment and behavioral health billing, as well as what these changes mean for some of the most common CPT codes our addiction treatment partners use day in and day out when providing medical services for people with SUD.
The Centers for Medicare and Medicaid Services Released their 2024 CPT code Update in Fall of 2023
As we covered in another recent post on 2024 Updates for CPT Codes H0017, H0018, and H0019, which mainly concern residential treatment, the CMS dropped their annual update on September 8th, 2023. The update press release is a pretty dry read but you can review it here.
When the CMS drops a new update to existing codes, it’s considered a “new codeset” - a shiny new box of codes that addiction treatment billers can use to communicate about services rendered with insurance payers.
Although this update contains 349 “editorial changes,” the actual changes that concern addiction treatment billing departments are very limited in scope.
Telehealth Rules Have Changed for 2024 CPT Codes and Addiction Treatment Billing
Perhaps the biggest change for 2024 is that telehealth billing rules were relaxed and further adapted. This change no doubt reflects the rising popularity - and lasting prevalence - of telehealth services for all patients in the post-COVID world, whether that’s in treatment settings for SUD, mental health, behavioral health or any other kind of healthcare.
In 2024, all in-home telehealth services are no longer eligible for in-facility rates, and, instead, must be billed at non-facility rates. This is easily achieved by adding the modifier, “95,” to all telehealth claims.
You can do this in addition to “place of service” modifiers like 02 and 10, which denote “telehealth provided other than in the patient's home,” and “telehealth provided in the patient's home,” respectively.
You can also add the modifier, “95,” in addition to other common CPT code modifiers that are specific to addiction treatment billing, like HA (programs for children under 18), HB (programs for adults), HD (programs from pregnant and nursing women), HF (substance use programs), HV (agencies funded by the state), and TG (addiction treatment programs that provide a complex and/or high level of care).
Any of these modifiers can be used in conjunction with the “95” modifier signifying non-facility
rates for telehealth services.
#1 Most Common CPT Code for Addiction Treatment in 2024: H0001HF
It all begins with H0001HF, the CPT code that represents introductory assessments for patients who are just entering treatment at a substance use program. H0001HF covers all of the time spent evaluating patients for the presence - as well as severity - of SUD using various clinical measures and a holistic biopsychosocial assessment of the state of the patient’s mental, physical and behavioral health at the time of admission to treatment.
Often, providers will add a taxonomy code to H0001HF, like 261QR0405X, which specifies that the assessment was performed by a provider who specializes in SUD treatment.
#2 Most Common CPT Code for Addiction Treatment in 2024: H0004HF
H0004HF picks up where the assessment leaves off and is used for all the billable hours spent in one-on-one therapy with the patient.
Like H0001HF, it uses the “HF” modifier to specify that the counseling sessions were hosted within the context of a substance use program. If you’re providing counseling services outside of a program specifically designed to treat SUD, then it’s likely the “HF” modifier would be substituted for another modifier. In that case, you may opt for HG (for an opioid treatment program), HH (for a dual diagnosis program), or HI (for a dual diagnosis program that also addresses developmental disabilities).
H004HF is used to bill for 15 minutes of service. If you’ve provided 60 minutes worth of one-on-one counseling, then you’d bill H0004HF four times.
#3 Most Common CPT Code for Addiction Treatment in 2024: 96164HF
96164HF is used for in-person (as opposed to telehealth) group counseling sessions. 96164HF represents 30 minutes worth of group counseling. If you’re providing a session that is one hour long, then you’ll nill 96164HF twice.
As with the other two previous CPT codes, this code uses an “HF” modifier to signify that services are taking place within the context of a program designed to specifically address SUD.
Other Useful Posts on Addiction Treatment Billing, CPT Codes and Reimbursement for SUD Services
Dive Into the Top 3 CPT Codes for Addiction Treatment: H0001HF, H0004HF, and 96164HF
Understanding HCPCS and CPT Billing Codes for Residential Addiction Treatment: H0017, H0018, H0019
2024 Update! Mastering CPT Codes for Residential Addiction Treatment Services: H0017, H0018, H0019
What Addiction Treatment CPT Codes Require Pre-Certification at Highmark, Inc.?
What Are the Most Used Addiction Treatment CPT Codes in Texas?
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