Billing of Substance Use Disorder (SUD) Services
Date: 12/01/17
Effective January 1, 2018, NH Healthy Families will be following the NH Medicaid billing guidelines for SUD services, outlined below:
Federally Qualified Health Centers (FQHCs) are to bill SUD services, except for Screening, Brief Intervention, and Referral to Treatment (SBIRT*) services, on a separate claim form and will be reimbursed at the SUD service’s State Medicaid Fee-for-Service (FFS) rate. FQHCs cannot bill SUD services as a medical or behavioral health encounter. (SBIRT* services are included in the encounter rate, as clarified in the October 2016 NH Medicaid Provider Bulletin.)
The following SUD codes are to be billed separately. Please see The State’s published rates for these SUD services.
H0001: Alcohol and/or Drug Assessment
H0004: Behavioral health counseling and therapy
U1 (30 minute session)
U2 (45 minute session)
U3 (60 minute session)
H0007: Crisis Intervention (OP) –In Provider Office or in the Community
U1: Crisis Intervention Services (first 60 minutes)
U2: Crisis Intervention Services (each additional 30 minutes)
H0005: Alcohol and/or drug services; group counseling by a clinician per person, per session
H0047-HS-HQ: Counseling, Family-Multi Family Group
H0047-HR-HQ: Family/couple with client present—Group setting
H0015: Intensive Outpatient Services
H2036: Partial Hospitalization Services
H0014: Medically Monitored Withdrawal Management
T1012: Non-peer recovery support, individual
T1012-HQ-FS: Non-peer recovery support, group
H0038: Peer Recovery Support, Individual
H0038-HQ: Peer Recovery Support, Group
H0006: Case Management (Continuous Recovery Monitoring-CRM)
With the exception of SBIRT codes, if the FQHCs bill the encounter code, T1015, along with a SUD code, the claim will be denied. The provider will have to resubmit the claim only using the SUD code and will be paid the FFS rate. If the provider bills T1015 along with a SUD code and another non-SUD code, the claim will be denied. The provider will have to resubmit two claims: one with the T1015 code and the non-SUD code and another claim with the SUD code.
If Medication Assisted Treatment (MAT) is rendered on the same day of a medical visit, the provider can bill T1015 for the medical visit and then on a separate claim bill one of the below E&M codes with modifier HF for the MAT office visit:
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
Other SUD services rendered on the same day as a MAT visit can be billed on the same claim as the MAT office visit.
If you have questions about the above billing policy, please contact Betsy Hippensteel, NH Medicaid Provider Relations Manager at 603-271-9414.
If you have questions about billing claims to NH Healthy Families, please contact provider services at: 1-866-769-3085.
As a reminder, all SUD claims should be sent to Cenpatico, NH Healthy Families’ behavioral health vendor.
Sincerely,
NH Healthy Families