What are the Most Used CPT Codes for Substance Abuse Billing?

Mastering CPT codes for substance abuse billing is crucial for maintaining a healthy revenue cycle in substance use disorder (SUD) treatment facilities. As the healthcare landscape becomes increasingly complex, understanding and correctly applying these codes can mean the difference between prompt reimbursement and costly denials. This comprehensive guide will explore the most commonly used CPT codes in substance abuse billing and provide essential insights for optimizing your billing practices.

Understanding CPT Code Categories in SUD Treatment

When it comes to substance abuse billing, several distinct categories of CPT codes are essential for accurately capturing the full spectrum of services provided. Each category serves a specific purpose in documenting different aspects of SUD treatment and ensuring proper reimbursement for the comprehensive care provided to patients struggling with substance use disorders.

Evaluation and Management (E/M) Codes

E/M codes form the backbone of initial patient assessments and ongoing treatment management in substance abuse billing. These codes capture:

• Initial patient evaluations and comprehensive assessments
• Treatment planning sessions and plan updates
• Ongoing care management and coordination
• Medical decision-making processes
• Medication management services
• Care coordination with other providers
• Patient education and counseling sessions

Psychiatric Diagnostic Evaluation Codes

These codes are specifically designed for comprehensive mental health and substance use assessments, including:

• Initial diagnostic interviews and evaluations
• Comprehensive patient histories and background collection
• Substance use pattern evaluation and assessment
• Risk assessment and safety planning
• Treatment recommendations and level of care determinations
• Family history and social support evaluation
• Co-occurring disorder screening and assessment

Psychotherapy Service Codes

Psychotherapy codes represent a significant portion of substance abuse billing, covering various therapeutic interventions:

• Individual therapy sessions at different time intervals
• Group therapy sessions and process groups
• Family therapy sessions and family education
• Crisis intervention services
• Skills development and coping strategies
• Relapse prevention planning
• Motivational enhancement therapy

Most Used CPT Codes in Substance Abuse Treatment

Individual Assessment and Evaluation

• 90791: Psychiatric diagnostic evaluation without medical services
  • Used for initial comprehensive assessments
  • Includes history gathering and mental status examination
  • Documents substance use patterns and severity
• 90792: Psychiatric diagnostic evaluation with medical services
  • Includes medical assessment components
  • Used when medication management is involved
  • Documents physical health impacts of substance use
• H0001: Alcohol and/or drug assessment
  • Specific to substance use evaluation
  • Documents severity and frequency of use
  • Includes withdrawal risk assessment

Individual Therapy Sessions

• 90832: Psychotherapy, 30 minutes
  • Brief intervention sessions
  • Crisis stabilization
  • Treatment plan updates
• 90834: Psychotherapy, 45 minutes
  • Standard individual therapy sessions
  • Processing and skill building
  • Relapse prevention planning
• 90837: Psychotherapy, 60 minutes
  • Extended processing sessions
  • Complex case management
  • In-depth therapeutic work

Group and Family Services

• 90853: Group psychotherapy
  • Process groups
  • Skills development groups
  • Psychoeducational sessions
• 90847: Family psychotherapy (with patient present)
  • Family systems work
  • Relationship repair
  • Support system development
• 90846: Family psychotherapy (without patient present)
  • Family education
  • Support system coaching
  • Collateral sessions

Intensive Outpatient Treatment

• H0015: Intensive outpatient treatment
  • Structured programming
  • Multiple weekly sessions
  • Comprehensive care coordination
• H0020: Medication-assisted treatment services
  • Medication management
  • Monitoring and adjustment
  • Integration with counseling services
• S9480: Intensive outpatient psychiatric services
  • Mental health focus
  • Co-occurring disorder treatment
  • Integrated care approaches

Special Considerations for SUD-Specific Coding

HCPCS Level II Codes

HCPCS Level II codes play a vital role in substance abuse billing, offering more specific options for SUD services:

• H0006: Alcohol and/or drug services
  • Case management
  • Service coordination
  • Recovery support
• H0047: Alcohol and/or drug counseling
  • Individual counseling
  • Recovery planning
  • Ongoing support
• H0050: Brief intervention services
  • Early intervention
  • Motivational interviewing
  • Prevention services

Time-Based Code Requirements

When using time-based codes in substance abuse billing, careful documentation is essential:

• Record actual face-to-face time spent with the patient
  • Start and end times
  • Service interruptions
  • Total duration
• Document time spent on:
  • Direct patient interaction
  • Care coordination
  • Documentation
• Ensure proper time thresholds:
  • 16-37 minutes for 30-minute codes
  • 38-52 minutes for 45-minute codes
  • 53+ minutes for 60-minute codes

Common Modifiers in SUD Billing

Understanding and correctly applying modifiers is crucial for accurate substance abuse billing:

• HF: Substance abuse program
  • Indicates specialized SUD services
  • Distinguishes from mental health treatment
• HD: Pregnant/parenting women’s program
  • Specialized treatment programs
  • Additional support services
• HH: Integrated mental health/substance abuse program
  • Co-occurring disorder treatment
  • Comprehensive care approach
• 59: Distinct procedural service
  • Separates bundled services
  • Justifies multiple services

Best Practices for CPT Code Selection

Documentation Requirements

Proper documentation is essential for supporting CPT code selection in substance abuse billing:

Include detailed service descriptions

• Document specific therapeutic interventions and techniques used
• Record patient’s response to treatment and progress
• Note any changes in treatment approach or plan
• Include rationale for service selection
• Document any coordination with other providers

Demonstrate medical necessity

• Link services to specific diagnosis codes
• Show connection to treatment plan goals
• Document patient’s current symptoms and challenges
• Include assessment of progress or barriers
• Support level of care decisions with clinical evidence

Time documentation requirements

• Record exact start and end times of sessions
• Note any interruptions or breaks in service
• Document face-to-face time separately from total time
• Include time spent on specific interventions
• Ensure documentation supports time-based codes used

Compliance Considerations

Maintain coding compliance through systematic approaches:

Regular internal audits

• Review documentation quality and completeness
• Check for proper code selection
• Verify modifier usage
• Ensure time documentation accuracy
• Monitor patterns in code usage

Staff training programs

• Provide ongoing education on coding updates
• Review common documentation errors
• Share best practices and successful examples
• Conduct case studies of complex coding scenarios
• Offer specialized training for new staff

Quality control measures

• Implement claim review processes before submission
• Use automated code checking systems
• Monitor denial patterns related to coding
• Track appeal success rates by code
• Document common coding challenges and solutions

Common Coding Errors to Avoid

Watch out for these frequent mistakes in substance abuse billing:

Service level errors

• Upcoding services without proper documentation
• Downcoding due to documentation gaps
• Mismatching service intensity with codes
• Incorrect level of care coding
• Improper use of time-based codes

Documentation deficiencies

• Insufficient detail to support code selection
• Missing required elements for specific codes
• Incomplete time documentation
• Lack of medical necessity support
• Poor alignment between services and treatment plan

Modifier mistakes

• Missing required modifiers
• Incorrect modifier combinations
• Overuse of modifier 59
• Failure to document modifier justification
• Inconsistent modifier usage

Code Selection Strategy

Implement a systematic approach to code selection:

Pre-service planning

• Review patient’s treatment plan and goals
• Check insurance coverage and requirements
• Verify medical necessity criteria
• Confirm appropriate level of care
• Plan for potential service combinations

During service documentation

• Record services as they occur
• Note specific interventions and time spent
• Document patient response and progress
• Track any changes in treatment approach
• Include all required elements for chosen codes

Post-service review

• Verify documentation completeness
• Check code and modifier accuracy
• Ensure time thresholds are met
• Review medical necessity support
• Confirm compliance with payer requirements

Click here for more best practices for optimizing your SUD revenue cycle

Should You Outsource Billing and Collections? 

Managing complex substance abuse billing in-house often diverts critical resources from patient care. As coding requirements and payer policies grow more demanding, partnering with specialized billing services offers a strategic solution that can transform your revenue cycle performance.

Professional billing partners provide:

• Specialized expertise in substance abuse billing and CPT code selection
• Advanced technology solutions without significant upfront investment
• Dedicated denial management and appeals processes
• Consistent billing operations despite staff turnover
• Ongoing compliance monitoring and risk management
• Improved clean claim rates and faster payment velocity
• Regular performance analytics and reporting

Outsourcing billing operations allows treatment centers to redirect resources toward their core mission—helping patients overcome substance use disorders. This strategic shift optimizes revenue through expert claims management while enabling clinical leadership to focus on program development and treatment outcomes.

Every claim you submit tells a story—a story of recovery, of transformation, and of lives being rebuilt. Mastering CPT codes for substance abuse billing ensures these stories translate into sustainable revenue that powers your mission forward. As payers demand greater specificity and compliance standards rise, your facility’s coding expertise becomes a critical differentiator between optimized reimbursement and costly denials.

The key to success lies in developing robust systems that support accurate code selection and documentation. This includes:

• Implementing thorough documentation protocols that capture all necessary elements for proper coding
• Investing in ongoing staff training to ensure consistency and accuracy in code selection
• Utilizing technology solutions that streamline the coding process and reduce errors
• Regularly reviewing and updating coding practices to align with current guidelines and payer requirements

Remember that effective CPT coding is not just about getting paid—it’s about accurately representing the valuable services provided to patients struggling with substance use disorders. When done correctly, proper coding supports both the financial health of your facility and the quality of patient care by ensuring resources are available for continued treatment excellence.

CTA: To read our full eBook titled “Mastering RCM for Substance Use Disorder Treatment: Overcoming Unique Billing Challenges” click here. 

How SimiTree Can Help

SimiTree’s behavioral health billing experts bring deep industry knowledge to substance use disorder treatment facilities struggling with complex CPT coding and revenue cycle challenges. 

Our comprehensive billing and collections services include expert claim submission, proactive follow-up, and dedicated utilization review services that ensure proper documentation supports your CPT code selection. 

With our designated client success managers and scalable solutions, we handle the intricacies of substance abuse billing while you focus on patient care. Our transparent approach helps you understand and overcome revenue barriers, maximize reimbursements, and maintain compliance with ever-changing billing requirements.

Frequently Asked Questions

What is the CPT code for substance abuse disorder? 

Common CPT codes for substance abuse disorder include 90791 (psychiatric diagnostic evaluation) and H0001 (alcohol and/or drug assessment). Other frequently used codes include 90832, 90834, and 90837 for individual therapy sessions of varying lengths.

What is the CPT code for SUD screening? 

The primary CPT code for substance use disorder screening is 99408 for screening lasting 15-30 minutes. For screenings lasting over 30 minutes, use CPT code 99409.

What is CPT code 99408 and 99409? 

CPT code 99408 covers alcohol and substance abuse screening and brief intervention services lasting 15-30 minutes. CPT code 99409 is used for the same services lasting more than 30 minutes.

What is the CPT code for subcutaneous drug administration? 

The primary CPT code for subcutaneous drug administration is 96372. This code is used for therapeutic, prophylactic, or diagnostic injection of medication administered subcutaneously or intramuscularly.