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Multiple Treatment Models
Practices may provide office-based treatment, outpatient care, intensive services, OTP treatment, counseling, and coordinated recovery support.
ADDICTION MEDICINE SERVICES
Addiction Medicine Services Built Around Complex Behavioral Health and SUD Billing.
Specialty-focused medical billing, coding, and revenue cycle support for addiction medicine practices, substance use disorder treatment, opioid use disorder care, medication management, counseling, toxicology services, and complex payer workflows.
LET'S CONNECT
Talk to Our Addiction Medicine Billing Team
Tell us about your addiction medicine practice, treatment model, payer mix, and revenue cycle needs.
WHY ADDICTION MEDICINE BILLING IS DIFFERENT
Addiction Medicine Billing Connects Clinical Care, Behavioral Health, Medication Management, and Payer Requirements.
Addiction medicine practices may combine substance use assessments, medication management, counseling, toxicology testing, care coordination, behavioral health services, and different levels of treatment. Billing must follow the documented service, treatment setting, diagnosis, and applicable payer rules.
02
OUD & SUD Coding
Claims may involve opioid use disorder, alcohol use disorder, stimulant use disorder, polysubstance use, and related behavioral health diagnoses.
03
Medication Management
Addiction medicine billing may include evaluation, medication management, treatment planning, follow-up, and other documented clinical services.
04
Counseling & Therapy
Individual and group counseling create documentation, service, timing, provider, and payer considerations that must align.
05
Toxicology Services
Drug testing and toxicology workflows require accurate documentation, order details, medical necessity, and appropriate claim review.
06
Authorization & Continued Care
Some payers and treatment settings may require prior authorization, utilization review, level-of-care information, or continued-service documentation.
END-TO-END REVENUE CYCLE SUPPORT
Addiction Medicine Medical Billing Services
From eligibility verification and charge capture through addiction medicine coding, claim submission, denial management, payment posting, and A/R follow-up, our workflow supports the full revenue cycle.
01
Insurance Verification
Verify eligibility, behavioral health benefits, coverage, patient responsibility, and applicable treatment requirements.
02Credentialing & Enrollment
Support provider enrollment, payer setup, credentialing, revalidation, and practice information maintenance.
03Charge Entry
Capture documented evaluations, treatment services, medication management, counseling, and applicable ancillary services.
04Addiction Medicine Coding
Review CPT, HCPCS, ICD-10-CM, E/M, documentation, diagnoses, service details, and payer-specific coding requirements.
05Claims Submission
Prepare, review, scrub, submit, and monitor addiction medicine and behavioral health claims.
06Denial Management
Investigate coding, documentation, authorization, eligibility, medical necessity, and payer processing issues.
07Payment Posting
Post ERA/EOB transactions, adjustments, patient responsibility, and remaining balances accurately.
08A/R Follow-Up
Monitor aging accounts, payer follow-up, unresolved balances, underpayments, and recovery of outstanding A/R.
OPIOID USE DISORDER & MEDICATION MANAGEMENT
Addiction Medicine Billing for OUD Treatment, Medication Management, and Recovery-Focused Care.
Opioid use disorder treatment may include medication management, substance use counseling, individual or group therapy, care coordination, assessments, toxicology testing, and other documented services depending on the treatment setting and applicable payer requirements.
Opioid Use Disorder
Billing workflows for documented OUD evaluation, ongoing treatment, medication management, and follow-up services.
Buprenorphine Treatment
Support for billing workflows involving documented buprenorphine treatment, follow-up, counseling, and related services.
Methadone Treatment
Workflow support for applicable methadone-related addiction treatment services and OTP claim requirements.
Naltrexone Treatment
Billing support for documented naltrexone treatment, medication management, follow-up, and associated services.
Medication Management
Review of documented assessment, treatment decisions, medication management, follow-up, and applicable E/M services.
Substance Use Counseling
Support for individual and group counseling workflows based on documented service requirements.
Care Coordination
Billing workflow support for applicable coordination, referrals, treatment planning, and recovery-related services.
Toxicology Testing
Claim review for documented toxicology and drug-testing services, including order, diagnosis, medical necessity, and payer requirements.
Assessment
→
Treatment Plan
→
Medication / Counseling
→
Documentation
→
Claim
SUBSTANCE USE DISORDER & BEHAVIORAL HEALTH
Billing Support for Substance Use Disorder, Behavioral Health, and Co-Occurring Care.
Addiction medicine practices may treat substance use disorders alongside psychiatric, behavioral, medical, and social needs. Billing workflows should connect diagnosis, treatment planning, service documentation, provider details, and payer requirements.
Discuss Your SUD Billing Workflow →
01
Alcohol Use Disorder
Support for documented assessment, treatment, counseling, medication management, and follow-up.
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Stimulant Use Disorder
Billing workflows for treatment services, behavioral interventions, monitoring, and documented follow-up.
03
Polysubstance Use
Claim review for multiple documented substance-related diagnoses and coordinated treatment services.
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Co-Occurring Conditions
Support for workflows involving substance use and co-occurring behavioral or psychiatric conditions.
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Individual Therapy
Coding and claim support for documented individual behavioral health and substance use therapy.
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Group Therapy
Workflow support for documented group treatment, participant records, service details, and payer review.
07
Recovery Support
Billing workflow coordination for applicable recovery-oriented services and patient support programs.
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Care Coordination
Support for applicable referrals, treatment coordination, follow-up, and communication across care settings.
TREATMENT SETTINGS & LEVELS OF CARE
Billing Support Across Outpatient Addiction Treatment and Structured Levels of Care.
Addiction treatment billing can span office-based services, outpatient treatment, intensive outpatient care, withdrawal management, structured programs, and continuing recovery services. Claims should reflect the actual treatment setting and documented services.
OFFICE-BASED
Office-Based SUD Treatment
Billing support for applicable office-based substance use disorder treatment, medication management, counseling, and care coordination.
OTP
Opioid Treatment Programs
Workflow support for applicable OTP billing, bundled treatment services, assessments, medications, and counseling.
OUTPATIENT
Outpatient Addiction Treatment
Support for documented evaluation, treatment, behavioral services, medication management, and follow-up.
IOP
Intensive Outpatient Programs
Billing workflow support for applicable IOP services, treatment planning, counseling, group care, and continued-service review.
PHP
Structured Behavioral Programs
Claim support for applicable structured treatment services, documented care intensity, utilization review, and payer requirements.
WITHDRAWAL
Withdrawal Management
Support for documented withdrawal-related treatment, medical management, monitoring, and applicable billing workflows.
RECOVERY
Continuing Care
Revenue cycle support for ongoing treatment, follow-up services, recovery planning, and patient re-engagement.
TELEHEALTH
Virtual Addiction Care
Billing workflow support for applicable telehealth addiction medicine services, payer requirements, and documentation.
DOCUMENTATION & MEDICAL NECESSITY
Strong Addiction Medicine Claims Start With Complete Clinical Documentation.
Addiction medicine billing depends on documentation that connects the patient’s condition, assessment, treatment plan, services delivered, medications, counseling, level of care, and ongoing clinical need.
Initial Assessment
Review documentation supporting the presenting concern, substance use history, clinical assessment, and treatment needs.
Substance Use Diagnosis
Align documented substance use disorders and related diagnoses with applicable ICD-10-CM coding requirements.
Treatment Plan
Support documentation of treatment goals, planned services, medications, counseling, and follow-up.
Medication Documentation
Review medication-related documentation, management decisions, follow-up, and applicable service details.
Counseling Notes
Check documentation of counseling or therapy services, participants, service details, and applicable time information.
Toxicology Documentation
Connect testing orders, clinical rationale, diagnosis, results, and claim documentation where applicable.
Level of Care
Review documentation supporting treatment intensity, utilization review, authorization, and continued-service decisions.
Medical Necessity
Organize documentation so the billed service is supported by the clinical record and applicable payer policy.
CPT • HCPCS • ICD-10-CM • CLAIM REVIEW
Addiction Medicine Coding That Connects Diagnosis, Service, Setting, and Documentation.
Addiction medicine coding may involve evaluation and management, behavioral health services, substance use treatment, medication-related services, toxicology, care coordination, and setting-specific billing rules.
ICD-10-CM Diagnosis Coding
Review documented substance use disorders, co-occurring conditions, and other diagnoses supporting the service.
CPT Coding
Support CPT selection for applicable evaluation, management, behavioral health, treatment, and related services.
HCPCS Coding
Review applicable HCPCS services, including setting-specific substance use treatment workflows.
E/M Services
Review documentation supporting evaluation and management and applicable medication-management encounters.
Behavioral Health Coding
Support coding workflows for documented counseling, therapy, behavioral health, and substance use treatment services.
Toxicology Coding
Coordinate documented testing services with diagnosis, medical necessity, laboratory details, and claim requirements.
Bundled Services Review
Identify applicable bundled-payment workflows and review services according to the treatment setting and payer rules.
Claim Edit & Modifier Review
Review applicable claim edits, modifiers, service details, place of service, and documentation before submission.
Documentation
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Diagnosis
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CPT / HCPCS
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Claim Review
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Submission
INSURANCE • AUTHORIZATION • UTILIZATION REVIEW
Addiction Medicine Insurance Verification and Prior Authorization Support.
Addiction treatment coverage may vary by payer, plan, treatment setting, benefit structure, and level of care. Our workflow organizes eligibility, authorization, documentation, and payer communication before claims move forward.
Eligibility Verification
Verify active coverage, member information, benefits, and applicable behavioral health or SUD treatment coverage.
Benefit Verification
Review deductibles, copays, coinsurance, network status, treatment benefits, and patient responsibility.
Prior Authorization
Coordinate applicable authorization requirements for services, treatment settings, medications, or continued care.
Utilization Review
Organize documentation needed for payer review, medical necessity assessment, and continued-service requests.
Level of Care Review
Support documentation workflows related to treatment intensity, admission, transition, and continued-service requirements.
Payer Policy Review
Review plan-specific billing requirements, claim rules, coverage policies, documentation, and submission details.
VERIFY
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REVIEW BENEFITS
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AUTHORIZE
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DOCUMENT
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SUBMIT
CLAIMS • DENIALS • A/R • REVENUE CYCLE
A Connected Addiction Medicine Revenue Cycle From Verification to Payment.
Addiction medicine billing works best when eligibility, treatment documentation, coding, authorization, claim submission, payment posting, denial resolution, and A/R follow-up operate as one connected workflow.
01
Verify
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Authorize
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Capture
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Code
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Review
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Submit
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Resolve
PRACTICE TYPES
Billing Support for Different Addiction Medicine Settings.
Our revenue cycle workflow can be structured around the services, treatment setting, payer mix, and documentation model of your practice.
Addiction Medicine Clinics
SUD Treatment Programs
Office-Based OUD Practices
Opioid Treatment Programs
Behavioral Health Practices
Integrated Care Practices
FREQUENTLY ASKED QUESTIONS
Addiction Medicine Billing FAQs
What are Addiction Medicine Services? +
Addiction Medicine Services may include evaluation and management,
substance use disorder treatment, medication management, counseling,
care coordination, recovery support, and other documented addiction-focused care.
What is addiction medicine billing? +
Addiction medicine billing is the process of translating documented
addiction treatment services into claims, submitting them to applicable
payers, posting payments, resolving denials, and managing outstanding A/R.
Do addiction medicine practices need specialized medical coding? +
Yes. Addiction medicine may involve substance use diagnoses,
behavioral health services, medication management, toxicology,
counseling, treatment programs, and payer-specific billing requirements.
What diagnoses can appear in addiction medicine billing? +
Depending on the documented clinical condition, claims may involve
opioid use disorder, alcohol use disorder, stimulant use disorder,
polysubstance use, and co-occurring behavioral or medical conditions.
Does addiction medicine billing include behavioral health services? +
It can. Depending on the treatment model and documented services,
addiction medicine workflows may include individual therapy, group therapy,
substance use counseling, care coordination, and related behavioral health services.
What is OTP billing? +
Opioid Treatment Program billing refers to billing workflows for
qualifying OTP services. Applicable payer rules can differ from office-based
substance use disorder treatment, so the treatment setting should be reviewed
before claim submission.
Can you handle addiction medicine denials? +
Denial management can include review of eligibility, coding,
documentation, authorization, medical necessity, payer processing,
claim edits, and appeal requirements.
01
Claim Rejections
Identify front-end claim errors, missing information, eligibility issues, and submission problems.
02
Claim Denials
Review denial reason codes, payer policies, documentation, authorization, and coding issues.
03
Payment Posting
Post ERA/EOB transactions, adjustments, patient responsibility, and outstanding balances.
04
A/R Management
Track aging balances, payer follow-up, unresolved accounts, underpayments, and recovery workflows.
ADDICTION MEDICINE RCM
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