Office-Based Substance Use Disorder (SUD) Treatment Billing

Office-based SUD treatment services are a way for physicians and non-physician practitioners to bill for a group of services in the office setting We cover a monthly bundle of services for the treatment of Opioid Use Disorder (OUD) or other SUDs.

How Do I Bill for Office-Based SUD Treatment Services?

Coding and billing for a monthly bundle of services for the treatment of SUD includes:

• Overall management
• Care coordination
• Individual and group psychotherapy
• Substance use counseling
• Add-on code for additional counseling

HCPCS Code for Office-Based SUD Treatment

Description

In the first calendar month:

• Developed the treatment plan
• Coordinated care
• Provided at least 70 minutes of office-based treatment for SUD, which could include development of the treatment plan, care coordination, individual therapy, group therapy, and counseling

In a subsequent calendar month:

• Coordinated care
• Provided at least 60 minutes of office-based treatment for SUD, which could include care coordination, individual therapy, group therapy, and counseling

• Coordinated care
• Provided more than 120 minutes of office-based treatment for SUD, which could include care coordination, individual therapy, group therapy, and counseling
  Note: Bill each additional 30 minutes separately and include the code for primary procedure

Medications prescribed as part of in-office treatment could include buprenorphine and naltrexone. If your patient has Medicare Part D coverage, these medications may be covered by their plan.

If you’re treating your patient in the office for OUD but feel they may benefit from a more comprehensive treatment, refer them to an OTP.