Substance Abuse Billing & Credentialing
For medical professionals and / or doctors that are running an office-based program for Buprenorphine treatment (Suboxone®, Subutex®3, Zubsolv®4, Bunavail™5, Probuphine®6), there are often many questions raised on how to properly do the medical billing when filing claims through the patient’s health insurance plan. There are multiple insurance companies that require specific credentialing and coding for substance abuse or opioid addiction treatment practices. Adhering to the correct ICD-10 and CPT codes of a patient’s claims is imperative, in order to get maximum reimbursement. Medwave has a dedicated team of professionals that handle your claims. This will put your mind at ease, making absolutely positive that your substance abuse practice’s future is in good hands.
Coding buprenorphine for primary care physicians
There has been much success with insurance companies now covering the cost of buprenorphine treatment in a primary care setting using regular evaluation and management codes. These codes would be based on the complexity of care or the time spent with the patient.
|99205 of a new patient with a comprehensive evaluation|
|99215 of an established patient with a comprehensive evaluation|
|New Patient||Established Patient|
|99201 10-19 minutes||99211 5-9 minutes|
|99202 20-29 minutes||99212 10-14 minutes|
|99203 30-44 minutes||99213 15-24 minutes|
|99204 45-59 minutes||99214 25-39 minutes|
|99205 60+ minutes||99215 40+ minutes|
|99211 5-9 minutes|
|99212 10-14 minutes|
|99213 15-24 minutes|
|99214 25-39 minutes|
|99215 40+ minutes|
There are currently some private health insurance carriers that are forming standard coding for these types of treatments with set reimbursement rates up to $300.00 per visit.
Mental Health Care, Unspecified
H0033 Administration of Oral Medication with direct observation.
Note to Medicaid Providers
If you are a Medicaid provider, you are bound by your contract to accept medical insurance as payment in full. It is illegal to ask patients to self-pay for treatment.
Medwave Billing & Credentialing has a dedicated team of medical billing and credentialing experts to help you maximize your office’s reimbursement and keep you up-to-date with today’s ever-changing medical billing and coding regulations. Our team is experienced and well educated in the medical billing and coding guidelines of specialists treating substance abuse and has firsthand experience working with commercial and government companies to get your claims paid fast and efficiently.
Our sole objective is to move your office to a more efficient and effective work process so that your claims reimbursement is at its maximum. Utilizing the most current ICD-10 and CPT coding ensures that your office’s claims are clean and paid the first time.
Contact us today to speak with someone on how we can be an affordable asset to you and your substance abuse treatment practice’s future in the Greater Pittsburgh region and the rest of the United States.