Substance use and IOP billing
Substance use and IOP billing services
We handle billing for substance use disorder programs, from outpatient counseling to intensive outpatient (IOP) and partial hospitalization (PHP). That includes per diem claims, Medicaid H-codes, authorizations and concurrent reviews. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- IOP and PHP per diem billing with the code set each payer expects
- Authorizations and concurrent reviews tracked by level of care
- Records handled with 42 CFR Part 2 consent rules in mind
Why substance use billing is different
Why substance use and IOP billing is different
SUD programs bill in ways most outpatient practices never see: per diem days, facility claim forms, state Medicaid H-codes and reviews every few days to keep a patient’s care approved.
The same service, different codes by payer
One IOP day may be billed with a revenue code on an institutional claim for one payer, S9480 or H0015 on a professional claim for another, and a state-specific code for Medicaid. We set up the right code set for each contract.
Per diem billing rules
IOP and PHP are often paid per day, not per session. Each billed day has to meet the program’s minimum hours and services, and the notes have to show it. Short days or missed groups can make a day unbillable.
Medicaid H-codes
Many state Medicaid programs and managed care plans use HCPCS H-codes for assessment, counseling and program days. Medicare generally does not recognize most H-codes, so the same service needs a different code for a Medicare patient.
Authorizations and concurrent reviews
Higher levels of care usually need an authorization before admission and a concurrent review to keep days approved. Clinical updates are often tied to level-of-care criteria such as ASAM. A missed review can leave days unpaid.
Drug testing
Presumptive and definitive drug tests use different codes, and payers limit how often each is paid. Standing orders without patient-specific medical necessity are a common denial reason.
42 CFR Part 2 confidentiality
Records from federally assisted SUD programs have extra federal protection beyond HIPAA. Disclosures, including some to payers, generally depend on patient consent. We work within your consent process and share only what a claim or review needs.
Common codes
Substance use and IOP codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| Revenue codes 0905 / 0906 | Intensive outpatient, psychiatric / chemical dependency (institutional claim) | Paired with the HCPCS or CPT the payer requires; units equal billed days |
| Revenue codes 0912 / 0913 | Partial hospitalization (institutional claim) | Daily hours and services meet the payer’s PHP rules |
| S9480 | Intensive outpatient psychiatric services, per diem | Commercial payer acceptance varies; authorization on file |
| H0015 | Alcohol and drug intensive outpatient program, per diem | Program minimum hours and days met; common with Medicaid and some commercial plans |
| H0035 | Mental health partial hospitalization, less than 24 hours | Payer accepts the code; daily documentation supports the per diem |
| H0001 / H0004 / H0005 | SUD assessment / individual counseling per 15 min / group counseling | Medicaid and plan-specific; units match time; not for Medicare |
| 90832–90837 / 90853 | Individual and group psychotherapy | Used for outpatient SUD counseling with commercial plans and Medicare |
| 80305–80307 / G0480–G0483 | Presumptive / definitive drug testing | Frequency limits and patient-specific orders |
Codes and rules change, and Medicaid code sets differ by state. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
SUD and IOP denials we stop before they happen
Most program denials come from authorizations, code sets and daily documentation. We check each one before the claim goes out.
- Days billed after an authorization ended or before a concurrent review was approved
- Per diem codes sent to a payer that expects revenue codes on an institutional claim, or the reverse
- H-codes sent to Medicare or to a commercial plan that does not accept them
- Program days billed without the minimum hours or services documented
- Drug tests over the payer’s frequency limit or without a patient-specific order
- Counseling units that do not match documented time
- Claims held up because required consent for disclosure was not on file
What we handle
Everything between admission and payment
- Insurance eligibility and benefits checks, including behavioral health carve-outs
- Authorization requests and concurrent review tracking by level of care
- Charge entry and coding review of per diem, H-code, psychotherapy and drug testing codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Credentialing and payer enrollment for clinicians and programs
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Behavioral health is our core focus. We sign a BAA with every client, and our staff are HIPAA-trained. Part 2 obligations stay with your program; we follow your consent process. This is general information, not legal advice.
Pricing
Clear pricing for SUD programs
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing.
Common questions
Should IOP be billed with S9480 or H0015?
It depends on the payer and your contract. S9480 is an intensive outpatient psychiatric per diem code, and H0015 is an alcohol and drug IOP per diem code. Some payers want neither and require revenue codes on an institutional claim. We confirm each payer’s current requirement.
Do you handle concurrent reviews?
We track authorization dates and review due dates, and we submit or follow up on reviews with the clinical updates your team provides. Your clinical staff decide the level of care. We make sure the paperwork reaches the payer on time.
Can you bill Medicaid H-codes?
Yes. We bill H-codes where the state Medicaid program or managed care plan uses them. Medicaid code sets and rates differ by state, so we check the current fee schedule and provider manual.
How do you handle 42 CFR Part 2?
We work within your program’s consent process and share only the information a claim, authorization or review needs. Part 2 generally requires patient consent for many disclosures of SUD treatment records. Your program remains responsible for its Part 2 compliance.
Do you bill Medicare for intensive outpatient?
Yes, where your program type is eligible. Medicare added an intensive outpatient benefit for certain facility types in 2024, with its own claim rules. We confirm eligibility and current rules before billing.
How much do substance use billing services cost?
Billing starts at 2.5% of collections, with flat monthly fees and dedicated billers also available. No setup fee and no long-term contract.
Guides from our team
Learn more before you decide
Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →How to Bill Insurance as a Therapist: A Step-by-Step Guide
How therapists get paid by insurance: verify benefits, code the session, submit the claim, post payments and work denials before filing deadlines.
Read the guide →Intensive Outpatient Program (IOP) Billing: Codes, Authorizations and Common Denials
How mental health and substance use IOPs are billed: S9480, H0015, revenue codes 0905/0906, per diem vs per service, authorizations and attendance documentation.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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