Medicaid Billing Software for Behavioral Health
With over 90 million Americans covered by Medicaid, public payers represent a critical revenue stream for addiction treatment centers. The BehaveHealth Medicaid Toolkit helps you verify eligibility in real-time, track claims from submission to payment, prevent denials before they happen, and maximize reimbursements for behavioral health services.
Medicaid Billing Features
Real-Time Eligibility Verification
Instantly verify Medicaid coverage before services are rendered. Confirm active enrollment, check covered benefits, and identify any restrictions or carve-outs specific to behavioral health.
Treatment Plan Documentation
Create clinical documentation that automatically ties to billable services. Progress notes link directly to HCPCS codes, ensuring every session generates a clean, compliant claim.
Authorization Tracking
Track prior authorization requirements and approval status for residential treatment, IOP, PHP, and other intensive services. Get alerts before authorizations expire so you never miss a renewal.
Claims Tracking & Management
Monitor every claim from submission through adjudication. Track payment status, identify pending claims, and surface detailed information to resolve issues quickly and accelerate collections.
Denial Prevention & Validation
Claims scrubbing catches common errors before submission. Validate coding accuracy, check for missing modifiers, and ensure documentation supports medical necessity to reduce denial rates.
Denial Management & Appeals
When denials occur, gather documentation and track appeal submissions. Monitor each denial from identification through resolution and surface patterns to prevent future issues.
Medicaid-Covered Addiction Treatment Services
Most state Medicaid programs cover the following behavioral health services when medically necessary. Click any billing code to view our detailed guide.
Outpatient Treatment
Individual and group counseling sessions for substance use and mental health disorders.
Intensive Outpatient (IOP)
Structured programs with 9+ hours weekly of group therapy and individual counseling.
Partial Hospitalization (PHP)
Day treatment programs providing intensive therapy without overnight stays.
Residential Treatment
24-hour structured care in non-hospital settings for substance use disorders.
Assessments & Evaluations
Comprehensive substance use disorder evaluations and psychiatric assessments.
Medical Detoxification
Medically supervised withdrawal management in various care settings.
Peer Support Services
Recovery coaching and mentoring by certified peer support specialists.
Medication-Assisted Treatment
Buprenorphine, methadone, and naltrexone services for opioid use disorder.
Services Typically NOT Covered by Medicaid
- Room and board at sober living homes or recovery residences
- Services rendered without required prior authorization
- Out-of-network providers (in most managed care plans)
- Non-clinical case management or life coaching
- Experimental treatments not approved by the state
State-by-State Medicaid Billing Guides
Each state administers Medicaid differently. Select your state for specific billing requirements, covered services, and reimbursement information.
Common HCPCS & CPT Codes for Medicaid Billing
Click any code below to view our comprehensive billing guide with documentation requirements, reimbursement rates, and compliance tips.
Assessment Codes
Therapy Codes
Intensive Services
Frequently Asked Questions
Medicaid covers approximately 12% of adults with substance use disorders, making it a significant payer for behavioral health services. While reimbursement rates are typically lower than commercial insurance, Medicaid provides a stable patient base and mission-aligned revenue. Many centers balance their payer mix by accepting both Medicaid and commercial insurance.
In most states, Medicaid does not reimburse for room and board at recovery residences. However, clinical services delivered in a recovery housing setting—such as individual counseling (H0004), group therapy (H0005), or peer support (H0038)—may be billable. Many operators use a hybrid model: Medicaid covers clinical services while residents pay privately for housing costs.
The end of continuous enrollment protections in 2023 triggered eligibility redeterminations nationwide. Many patients lost coverage—not due to income changes, but because of procedural issues like unreturned paperwork. Providers should verify eligibility before every service and help patients navigate the renewal process to maintain continuous coverage.
Requirements vary by state and service type. Residential treatment, extended IOP episodes, and higher levels of care almost always require prior authorization. Some states require authorization for PHP, psychological testing, or services beyond a certain number of units. Always verify requirements with your state Medicaid program or managed care organization before rendering services.
Focus on five key areas: (1) Verify eligibility before each service date, (2) Obtain all required prior authorizations, (3) Document medical necessity thoroughly using ASAM criteria, (4) Use correct HCPCS/CPT codes with appropriate modifiers, and (5) Submit claims within state filing deadlines. Implementing claims scrubbing software can catch errors before submission.
Most states cover peer support under HCPCS code H0038 in 15-minute increments. For telehealth delivery, add the GT modifier. For group services, add the HQ modifier. Ensure your peer specialists meet state certification requirements, and document the recovery-oriented interventions provided during each session.
Related Resources
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Important Disclaimer
The information on this page is provided for educational purposes only and does not constitute legal advice, medical advice, tax advice, financial advice, compliance guidance, regulatory interpretation, or professional medical billing advice.
Medicaid rules, covered services, reimbursement rates, and billing requirements vary significantly by state and are subject to frequent changes. Coverage determinations depend on individual patient circumstances, specific plan provisions, and state-level policies.
Before making billing decisions or accepting patients, consult with a licensed attorney, qualified healthcare compliance consultant, certified medical billing specialist, tax advisor, and/or your state Medicaid agency. BehaveHealth assumes no liability for actions taken based on this content.