CPT codes for inpatient substance abuse MAT treatment, mostly with suboxone and subutex.

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I work at a 3rd party medical billing office working primarily with substance abuse treatment centers. We cant figure out what CPT codes to check with the Payers to see if MAT is valid and billable inpatient or outpatient in a facility. Anyone find a work-around for this?


Atlanta, GA
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Hi Taliafate
Ensure document properly, listing medication prescribed given, and dx range from F11 to F14 F16 F17 linking with description of care given. Medicare coverage is lsited as such...there are 17 billable OTP-only HCPCS G-codes (G2067 to G2080, G2215, G2216, and G1028) for opioid treatment services on Part B claims. HCPCS codes G2067 to G2073, G2215, G2216, and G1028 cover all FDA-approved drugs for the treatment
Commercial payers usually want pre authorization done first date for weekly or monthly care and injections or medications given. Use definitive dx codes F10 to F19 opioids smoking,cocaine, pot, inhalents, alcohol Etc. However can add other beh health conditions patient may suffer with such as: Bipolar, Anxiety Depression, Schizo if warranted to per patients problems. Use Z codes on claims last, Z79, Z51.81 Z76, Z63.72,Z81.1 Z91, Z87 891 ,Z02.83 if blood drug testing, dx R78 if corresponding with notations.Check out dx blocks of R44 to R46 give descriptive mental health symptoms can add in if clinical staff document. Your clinical staff MD NP PA should use Eval Mgt codes and if give MH therapy/counseling given add CPT 90832-90834, 90792, 90291 same time. Inpt. consult care codes can be used but must add referring docs name and minutes CPT 99251-99255. Inpt visit for psych wards LPC and LCSW can only use CPT 90832-90834. Whereas MD, DO NP and PA can use int. pt subsequent visit 99221 -99223 and crisis codes CPT 90839 -90840. The record will need to specify if discuss medical problems vs mental health disease & treatment on same record and minutes for each session in record. Smoking or drug discussion can use outpt. CPT 99401 to 99409. Ensure add time in medical records for each treatment.

I hope this data helps you. Also there is list telehealth can be used too in outpatient setting for beh health staff.
Lady T