G2087: Mastering Subsequent Month Opioid Use Disorder Treatment Billing
Table of Contents
Introduction
G2087 Overview
Detailed Breakdown
Impact on Healthcare System
Billing Best Practices
Compliance and Regulation
Future Trends and Updates
Conclusion
Disclaimer: The information provided in this article is for educational purposes only and should not be construed as legal, financial, or medical billing advice. Healthcare providers, medical billers, and administrators should consult with qualified professionals and refer to official guidelines for specific billing and compliance requirements. The content publisher assumes no liability for any actions taken based on the information presented in this article.
Introduction
In 2021, the National Survey on Drug Use and Health reported that 46.3 million people aged 12 or older had a substance use disorder (SUD) in the past year, with 9.2 million people specifically struggling with opioid use disorder (OUD). This staggering statistic underscores the critical importance of comprehensive, ongoing treatment for individuals with OUD. For healthcare providers offering these vital services, understanding the intricacies of billing, particularly the use of HCPCS code G2087, is essential for ensuring proper reimbursement and maintaining financial stability.
This comprehensive guide will delve into the details of G2087, providing valuable insights for healthcare professionals seeking to optimize their billing practices and ensure compliance when offering subsequent month opioid use disorder treatment services. By the end of this article, you'll have a thorough understanding of G2087, its significance in the healthcare system, best practices for billing, compliance considerations, and future trends.
G2087 Overview
G2087 is a Healthcare Common Procedure Coding System (HCPCS) Level II code that represents "Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month".
Purpose and Significance
The primary purpose of G2087 is to enable healthcare providers to accurately bill for ongoing opioid use disorder treatment services provided in an office-based setting after the initial month of treatment. This code recognizes the importance of continuous care and support for individuals with OUD beyond the initial treatment phase.
G2087 is significant because it:
Supports the delivery of comprehensive, long-term care for patients with OUD
Encourages providers to offer ongoing treatment and support services
Allows for more accurate billing and reimbursement for time-intensive services
Promotes a patient-centered approach to OUD treatment
Aligns with the growing emphasis on integrated, holistic care for substance use disorders
Quick Facts
Code Type: HCPCS Level II
Service Category: Office-Based Opioid Use Disorder Treatment
Billing Unit: Per calendar month
Minimum Time Requirement: At least 60 minutes of services
Effective Date: January 1, 2020
Detailed Breakdown
Components and Requirements of G2087
To bill G2087 correctly, providers must understand its components and requirements:
Subsequent Month Services: G2087 is used for billing OUD treatment services provided in any month following the initial month of treatment (which is billed using G2086).
Time Threshold: At least 60 minutes of services must be provided during the calendar month to bill G2087.
Service Components: The services billed under G2087 must include:
Care coordination
Individual therapy
Group therapy and counseling
Provider Qualifications: Services must be delivered by qualified healthcare professionals in an office-based setting.
Documentation: Detailed documentation of the services provided, including start and end times, is essential for supporting G2087 claims.
Common Pitfalls and How to Avoid Them
Incorrect Code Usage: Ensure that G2087 is only used for subsequent months of treatment, not the initial month.
Insufficient Time: Verify that at least 60 minutes of services have been provided during the calendar month before billing G2087.
Incomplete Service Components: Make sure all required components (care coordination, individual therapy, and group therapy/counseling) are included in the treatment plan.
Inadequate Documentation: Maintain comprehensive records detailing the specific services provided, including time spent on each component.
Billing Without Medical Necessity: Clearly document the ongoing need for OUD treatment to support medical necessity for continued services.
At BehaveHealth.com, we offer comprehensive billing solutions designed to help substance use disorder treatment providers navigate these common pitfalls and optimize their G2087 billing processes.
Impact on Healthcare System
Effects on Patients
For individuals struggling with opioid use disorder, access to ongoing, comprehensive treatment can be life-changing. A study found that longer duration of care was associated with improved treatment outcomes and reduced risk of relapse for individuals with OUD.
Ongoing office-based OUD treatment services billed under G2087 provide patients with:
Consistent support throughout their recovery journey
Regular access to individual and group therapy
Continued care coordination to address evolving needs
Improved chances of long-term recovery and relapse prevention
Enhanced overall quality of life and social functioning
By enabling providers to bill for these ongoing services using G2087, more individuals with OUD can access the continuous care they need to achieve and maintain recovery.
Impact on Providers
Providers benefit from the ability to offer and be reimbursed for ongoing OUD treatment services that address the complex, long-term needs of individuals with opioid use disorder. By using G2087, they can receive appropriate compensation for the time and resources invested in delivering comprehensive care beyond the initial treatment phase. However, providers must also ensure they have robust systems in place to track and document all treatment activities to support the use of this code.
The specific nature of G2087 allows providers to tailor their services to the evolving needs of each patient as they progress through their recovery journey. This can lead to more personalized and effective treatment approaches.
Considerations for Payers
For payers, G2087 represents an investment in comprehensive, long-term OUD treatment that can lead to significant cost savings over time. A report from the National Institute on Drug Abuse found that every dollar invested in addiction treatment yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft.
However, payers may require detailed documentation and outcome measures to ensure that the ongoing services provided under G2087 are effective and justify the continued reimbursement. This can include metrics such as reduced opioid use, improved treatment retention, and decreased utilization of higher levels of care.
Billing Best Practices
To maximize compliant reimbursement when using G2087, follow these best practices:
Step-by-Step Billing Guide
Verify Patient Eligibility: Confirm the patient's coverage and any pre-authorization requirements for ongoing OUD treatment services.
Document Services Thoroughly: Maintain detailed records of all treatment activities, including start and end times, specific interventions used, and progress towards treatment goals.
Calculate Time Accurately: Ensure that at least 60 minutes of services have been provided during the calendar month before billing G2087.
Use Appropriate Modifiers: Apply relevant modifiers as needed to indicate specific circumstances or to differentiate between multiple services.
Submit Claims Timely: Adhere to payer-specific timely filing deadlines to avoid claim denials.
Reimbursement Rates Overview
Reimbursement rates for G2087 can vary across payers and geographic regions. While specific rates are not provided here due to their variability, it's important to note that:
Medicare rates for G2087 in 2023 were approximately $345.96 for non-facility settings and $280.86 for facility settings
Medicaid rates may vary by state and program type
Private insurers may have negotiated rates as part of provider contracts
Expert Tips for Maximizing Compliant Reimbursement
Implement a Robust Time-Tracking System: Use electronic health records (EHRs) or specialized software to accurately track and document treatment session durations.
Conduct Regular Internal Audits: Periodically review your billing practices to identify and correct any issues before they become compliance problems.
Stay Informed About Payer Policies: Regularly review and update your knowledge of payer-specific guidelines for G2087 billing.
Invest in Staff Training: Ensure that all staff involved in OUD treatment and billing are well-trained on proper documentation and coding practices.
Utilize Billing Software: Implement specialized billing software that can help identify potential errors or inconsistencies in G2087 claims.
BehaveHealth.com offers advanced billing solutions that can help substance use disorder treatment providers streamline their G2087 billing processes and maximize reimbursement while ensuring compliance.
Compliance and Regulation
Adhering to compliance regulations is crucial when billing G2087 to avoid legal and financial risks.
Key Laws and Policies
Health Insurance Portability and Accountability Act (HIPAA): Ensure patient privacy and secure handling of protected health information.
False Claims Act (FCA): Avoid submitting false or fraudulent claims to federal healthcare programs. Violations can result in significant penalties and legal action.
Substance Abuse and Mental Health Services Administration (SAMHSA) Regulations: Comply with federal guidelines for substance use disorder treatment services.
State-Specific Regulations: Be aware of any state laws governing opioid use disorder treatment program operations and billing practices.
Legal, Financial, and Business Risks
Submitting inaccurate claims can lead to audits, recoupments, and potential legal action.
Inadequate documentation may result in claim denials and loss of revenue.
Non-compliance with regulations can lead to fines, loss of licensure, and reputational damage.
10-Point Actionable Compliance Checklist
Develop and maintain a comprehensive compliance program
Regularly train staff on billing and documentation requirements
Implement internal auditing procedures for G2087 claims
Stay updated on changes to billing regulations and payer policies
Ensure all required licenses and certifications are current
Maintain accurate and complete patient records
Implement a system for tracking and resolving billing discrepancies
Establish protocols for handling and reporting compliance issues
Regularly review and update policies and procedures
Conduct periodic risk assessments related to G2087 billing
Future Trends and Updates
The landscape of opioid use disorder treatment and related billing practices is continually evolving. While specific predictions about G2087 cannot be made with certainty, several trends are likely to shape its future use:
Increased Integration with Telehealth: As telehealth becomes more prevalent, there may be changes to how G2087 is applied to virtual OUD treatment services.
Enhanced Focus on Outcomes: Payers may require more detailed reporting on the outcomes of ongoing treatment to justify continued reimbursement under G2087.
Expansion of Covered Services: There may be increased attention to incorporating additional evidence-based interventions under the umbrella of G2087 billing.
Focus on Value-Based Care: There may be a shift towards value-based reimbursement models for OUD treatment services, potentially affecting how G2087 is used and reimbursed.
Emphasis on Integrated Care: Ongoing OUD treatment may increasingly focus on addressing co-occurring mental health and physical health conditions alongside substance use disorders.
At BehaveHealth.com, we stay current with industry changes through continuous monitoring of regulatory updates, participation in professional organizations, and ongoing staff education. This commitment ensures that our clients always have access to the most up-to-date billing practices and compliance information.
Conclusion
Understanding and properly utilizing the G2087 billing code is essential for healthcare providers offering ongoing office-based opioid use disorder treatment services. By following best practices, staying compliant with regulations, and keeping abreast of industry trends, providers can ensure accurate reimbursement while delivering high-quality care that addresses the complex, long-term needs of individuals with OUD.
As the healthcare landscape continues to evolve, it's crucial to have reliable partners in navigating the complexities of substance use disorder treatment billing. BehaveHealth.com offers cutting-edge solutions designed to streamline your billing processes, enhance compliance, and maximize reimbursement for services billed under G2087 and other related codes.
To learn more about how BehaveHealth.com can support your opioid use disorder treatment billing needs, explore our comprehensive suite of billing solutions and expert consulting services. Visit BehaveHealth.com today to discover how we can help you optimize your billing practices and focus on what matters most – providing effective, ongoing treatment that can change lives and promote long-term recovery from opioid use disorder.
Last Updated: September 20, 2024
Additional Resources
Blog homepage (for general addiction treatment and billing resources)
Features page (for information on EHR capabilities)