The need for coping skills and having a healthy outlet has become a necessity for today’s society. On average, there has been a significant increase in people who suffer from substance abuse. When asked what they believed led to their depression or dependence on drugs, 70% reported that they did not address an issue that might have led to a bigger problem. They lacked the support they needed for the tough time they were facing, thus choosing an easier route: the deadly suppressant that drugs and alcohol offer.

We have encountered numerous providers who have incorporated a range of services into their facilities to better accommodate patients who have expressed an interest in receiving continuous care for their mental health needs. It is also important to note that providers have not had much success in getting reimbursed using their current billing methods.

In light of this, we have been inundated with questions from physicians, providers, and administrators about the appropriate procedures, diagnosis codes, and modifiers required to process and pay their claims without incident. We understand the need for more support and clearer guidelines to navigate the complexities of billing for behavioral health services! However, keep in mind that there are many variables to be considered, and it might get complicated! Since the topic of behavioral health may be considered a broad subject, we have limited this newsletter to mostly cover substance abuse scenarios in clinical settings.

Below are some guided tips to share with your partners as well as your billing team:

Code: H0004 MODIFIER: HF TELEMED MODIFIER: GT

Description: For Behavioral health counseling and therapy, per 15 minutes

When can I bill this?

One-on-one sessions either in person or via telemedicine.

Example: The claim line should look like this: H0004-HF, GT, or H0004-HF.

Code: H0003 MODIFIER: NONE REQUIRED

Description: For alcohol and/or drug screening, laboratory analysis of specimens for the presence of alcohol and/or drugs.

When can I bill this?

Assuming that you are a qualified healthcare provider and the tests were ordered by you:

• The analysis is performed in a laboratory setting.
• The screening is for drugs and/or alcohol
• Interpretation and results are reported to the ordering provider

ALERT!

If applicable, make sure your CLIA number is attached to the claim before submitting it!

Code: H0005 MODIFIER: Required for reimbursement! This depends on the provider’s credentials. *See below for a list of modifiers.*

Description: Alcohol and/or drug services; group counseling by a clinician (up to 60 minutes)

When can I bill this?

This code is used for intensive outpatient services, which include group therapy, family therapy, and medication management. We recommend using this code in a group setting of no more than ten patients.

Code: 90853 MODIFIER: Circumstantial

Description: This represents group therapy sessions that can focus on a variety of mental health issues, such as anxiety, depression, substance abuse, and more.

When can I bill this?

This code is used to bill for group therapy services, in which a therapist works with at least two patients in a therapeutic setting. As stated above, this is a more comprehensive code, whereas H0005 primarily deals with behavioral, drug, alcohol, and addiction treatment.

Examples of Reimbursable Diagnosis Codes

ICD-10 CODE: F10

Description: Alcohol-related disorders

ICD-10 CODE: F19.99

Description: Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder

ICD-10 CODE: F55.0

Description: Abuse of antacids

ICD-10 CODE: F55.8

Description: Abuse of other non-psychoactive substances

MODIFIERS: PRN

If you read our article a few years back on the importance of modifiers and the role they play in the reimbursement of your claims, then this next part should be less complicated to follow.

The modifiers below are as needed, as the title states. However, for your convenience, we will highlight the key modifiers that are always attached to specific procedure codes when billing your claims.

HF–> Substance abuse program. Indicates services provided as part of a substance abuse program.

Example: All of the CPT/HCPCS codes mentioned above should have an HF if the service is part of a program.

HN–> Bachelor’s degree level

Example: Including but not limited to: H0003, H0004, H0005, 90853

HO–>Master’s degree level

Example: Including, but not limited to: H0005, H0047, 90853

QW–>used to indicate that a test is a Clinical Laboratory Improvement Amendment (CLIA) waived test and was performed by a lab with a CLIA certificate.

Example: Any qualified laboratory test!

76,59–> used mostly for either allowable repeat procedures or as an indicator to insurance companies that a service that is normally billed alone was instead billed in addition to another service.

Example: You use H0004 and also interpreted and reviewed the patient’s behavioral assessment: H0004-HF,96127-59

Document, Document, Document!!!

We could advise you and provide payable codes and diagnoses all day long, but if you don’t have the documentation for what you are billing, it will be of no use to you. If you are looking for longevity and credibility but, most importantly, REFERRALS from insurance companies, you will take care to ensure that your practice is functioning by the book and you are compliant.

Although these codes suggested are billable and payable, multiple scenarios will vary. Please have your billing team and/or front office validate that these procedures are covered services prior to performing them. In addition, ensure that you always follow state and local guidelines!

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