For hospital detox units, medically monitored and residential withdrawal management programs, and ambulatory detox clinics.
Detox revenue disappears one day at a time. A continued-stay review goes in after the last authorized day, the discharge day gets billed as a bed day, or a Medicare stay goes out with H codes Medicare never pays. Luxen bills withdrawal management inside your EHR, starting with benefits checks and authorizations at admission and running through every concurrent review, facility per diem and physician visit to discharge.
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Detox billing services manage insurance claims for withdrawal management: hospital detox stays paid by MS-DRG, residential detox days billed with H0010 or H0011, and ambulatory detox billed with H0014. The work centers on authorizations and concurrent reviews. In the Luxen claim audit, reviews filed after the last authorized day caused 26% of detox denials.
Detox billing changes with the setting, the acuity and who pays.
Most programs also bill urine drug testing, medication induction and the step-down into residential or outpatient care, which our substance abuse billing team carries forward on the same account. We run the full revenue cycle across every line.
Most lost detox revenue is a day nobody authorized, a day billed in error, or a visit nobody charged. E/M dollar figures are 2026 Medicare national facility rates at the $33.4009 conversion factor, which vary by locality.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Admission after business hours | H0010, H0011 | Authorization not confirmed until the next business day | Each day before authorization starts | Eligibility and coverage errors caused 24% of denials |
| Continued-stay review due | H0010, H0011, revenue code 0116 | Review sent after the last authorized day | Contracted per diem for each uncovered day | Continued-stay reviews filed after the last authorized day caused 26% of detox denials |
| Patient discharged | Revenue codes 0116, 0126, 1002 | Discharge day billed as a bed day | One per diem, plus recoupment | The discharge day was billed as a covered bed day on 6% of detox facility claims |
| High-severity withdrawal admission | 99223, 99222 | High medical decision making documented, moderate level billed | $39.42 per admission ($156.32 less $116.90) | Admission notes re-leveled to the documented decision making |
| Medicare inpatient detox stay | MS-DRG 896, 897; H0008, H0009 | H code lines sent on a Medicare hospital claim | The full stay | Coding and modifier errors caused 21% of denials |
| Drug screens in the first week | 80305 to 80307 | More than 3 presumptive tests in a rolling 7 days | Each test past the limit | Presumptive drug screens exceeded the payer frequency limit on 12% of detox stays |
Detox H codes describe a setting and an acuity, not an ASAM level, and each state Medicaid program builds its own crosswalk. Pairing them correctly is the first job of our certified coders.
| Code | Setting in the descriptor | Acuity |
|---|---|---|
| H0008 | Hospital inpatient | Sub-acute |
| H0009 | Hospital inpatient | Acute |
| H0010 | Residential addiction program inpatient | Sub-acute |
| H0011 | Residential addiction program inpatient | Acute |
| H0012 | Residential addiction program outpatient | Sub-acute |
| H0013 | Residential addiction program outpatient | Acute |
| H0014 | Ambulatory detoxification | Not stated |
H0014 is not a per diem code. Its descriptor sets no unit, so the payer decides whether a unit is an hour, a visit or a day.
| Revenue code | Accommodation |
|---|---|
| 0116 | Private room, detoxification |
| 0126 | Semi-private, two beds, detoxification |
| 0136 | Three and four beds, detoxification |
| 0146 | Deluxe private, detoxification |
| 0156 | Ward, detoxification |
| 1002 | Residential treatment, chemical dependency |
Bill the room the patient actually occupied. Medicare pays the same routine rate whether or not a private room was medically necessary, and never pays for deluxe accommodations.
The third edition of the ASAM Criteria splits withdrawal management into 1-WM and 2-WM ambulatory care, 3.2-WM clinically managed residential, 3.7-WM medically monitored inpatient and 4-WM medically managed intensive inpatient. The fourth edition folds these into the main levels: 1-WM maps to 1.7, 2-WM to 2.7, 3.2-WM to 3.5 and 3.7-WM to 3.7. Confirm which edition each payer uses so the authorized level matches the claim.
Montana Medicaid pays H0010 as medically monitored intensive inpatient care (ASAM 3.7) and H0011 as clinically managed residential withdrawal management (3.2-WM), both per day. Connecticut Medicaid uses H0014 for 1-WM billed hourly, where 30 to 89 minutes is one hour and under 30 minutes is not billable, and H0012 for 2-WM lasting more than 4 hours a day.
Traditional Medicare covers detox as an inpatient hospital stay. It does not cover non-hospital residential substance use care, and H0008 to H0014 carry HCPCS coverage code I, not payable by Medicare.
NCD 130.1 covers inpatient alcohol detoxification when the likelihood of complications such as delirium, confusion, trauma or unconsciousness requires physicians and equipment found only in a hospital. Detox generally takes two to three days, occasionally five, and longer stays need physician documentation. NCD 130.6 extends inpatient coverage to drug detoxification when medically necessary. The admission should also meet the two-midnight benchmark in 42 CFR 412.3(d).
| MS-DRG | Title |
|---|---|
| 894 | Alcohol, Drug Abuse or Dependence, Left AMA |
| 895 | Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy |
| 896 | Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC |
| 897 | Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC |
Code the withdrawal state with a combination code, such as F10.230 alcohol dependence with withdrawal, uncomplicated, F11.23 opioid dependence with withdrawal, or F13.230 sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated.
| Code | Visit | 2026 Medicare national rate |
|---|---|---|
| 99221 | Initial, straightforward or low decision making | $74.48 |
| 99222 | Initial, moderate decision making | $116.90 |
| 99223 | Initial, high decision making | $156.32 |
| 99231 | Subsequent, straightforward or low | $44.09 |
| 99232 | Subsequent, moderate | $70.48 |
| 99233 | Subsequent, high | $106.88 |
| 99238 | Discharge, 30 minutes or less | $74.82 |
| 99239 | Discharge, more than 30 minutes | $106.55 |
Professional visits go out on a CMS-1500 claim separate from the hospital claim, and each day on the census needs a signed note behind the charge. Discharge day management is chosen by time, so the note needs total minutes spent on the discharge date to support 99239 over 99238.
Presumptive tests bill with 80305 to 80307 by method complexity. Definitive tests bill with G0480 to G0483 by number of drug classes (1 to 7, 8 to 14, 15 to 21, 22 or more) or with G0659, and NCCI allows one unit per date of service. G0659 covers definitive testing run without drug-specific calibration or matrix-matched quality control, for any number of drug classes. Palmetto GBA Medicare LCD L35724 sets these limits, and a test past them is not covered by Medicare:
| Days of abstinence | Presumptive tests | Definitive tests |
|---|---|---|
| 0 to 30 | 3 per rolling 7 days | 1 per rolling 7 days |
| 31 to 90 | 3 per rolling 7 days | 3 per rolling 30 days |
| Over 90 | 3 per rolling 30 days | 3 per rolling 90 days |
Commercial and Medicaid plans publish their own limits, so match each standing order to the payer policy before the first specimen.
Under 21 CFR 1306.07(b), a practitioner not registered as an opioid treatment program may dispense, but not prescribe, narcotic drugs to start maintenance or detoxification treatment, no more than a three-day supply at one time while a referral is arranged. No federal waiver has been needed to prescribe buprenorphine since December 29, 2022.
Office-based follow-up can bill Medicare bundles G2086 for the first month (at least 70 minutes) and G2087 for later months (at least 60 minutes), plus G2088 for each additional 30 minutes past 120. Medicare has accepted the patient home as the telehealth originating site for substance use disorder treatment since July 1, 2019. DEA telemedicine prescribing flexibilities run through December 31, 2026, and 21 CFR 1306.51 permits buprenorphine prescribing by audio-only telemedicine for six calendar months from the first prescription.
The rule: H0008 to H0014 carry HCPCS coverage code I, not payable by Medicare, and Medicare pays covered inpatient detox as an MS-DRG under NCD 130.1. The cost: the whole stay comes back. In our claim audit, coding and modifier errors caused 21% of denials.
The rule: NCD 130.1 says coverage ends when detox no longer requires a hospital setting. Under 29 CFR 2560.503-1, an urgent extension gets a 24-hour decision only if requested at least 24 hours before the approved period ends. The cost: a per diem for every day after the last covered day, unless denial and AR recovery work wins it back on appeal. Continued-stay reviews filed after the last authorized day caused 26% of detox denials.
The rule: Medicare Benefit Policy Manual chapter 3, section 20.1 does not count the day of discharge, and a same-day admission and discharge counts as one day. The cost: one per diem per stay, plus recoupment. The discharge day was billed as a covered bed day on 6% of detox facility claims.
The rule: LCD L35724 covers no more than 3 presumptive tests in a rolling 7 days during the first 30 days of abstinence. The cost: every screen past the limit. Presumptive drug screens exceeded the payer frequency limit on 12% of detox stays.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Detox programs run on behavioral health EHRs such as Kipu, Sunwave, Lightning Step, BestNotes and Qualifacts CareLogic. Hospital detox units document in Epic or Oracle Health, and addiction medicine groups often use eClinicalWorks or athenahealth. We work inside the system you already use: census, admission and discharge times, withdrawal scores, authorization dates and signed progress notes stay where your clinicians enter them. No migration and no second chart, and your Part 2 consent stays attached to the record we bill from.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Admission and discharge times were not being reconciled against our daily detox charges. Luxen found 137 unbilled patient days, corrected the affected accounts, and recovered $68,500.
Facility Administrator, inpatient detoxification center
Concurrent reviews and authorization extensions were tracked outside the billing system, so covered days were sometimes written off. Luxen introduced a daily review process that reduced uncovered treatment days from 11% to 2.3%.
Revenue Cycle Manager, medically supervised detox program
Full engagements are written up in our dental practice case study and our ambulance billing case study.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, month to month with 30 days notice and no setup or exit fee. Take a 16-bed medically monitored detox program collecting $160,000 a month: $132,000 from facility per diems and $28,000 from physician visits and drug testing.
| Service line | Monthly collections | In-house at 7.9% | Luxen at 3% | Luxen at 6% |
|---|---|---|---|---|
| Facility per diems | $132,000 | $10,428 | $3,960 | $7,920 |
| Physician visits and drug testing | $28,000 | $2,212 | $840 | $1,680 |
| Total | $160,000 | $12,640 | $4,800 | $9,600 |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data, and this program collects $1.92M a year. Luxen at 3% costs $7,840 a month less than in-house; at 6%, $3,040 less.
Ask these questions before you sign:
| Partner type | Concurrent reviews | Facility and professional claims | Pricing and terms |
|---|---|---|---|
| In-house | Your staff, nights and weekends included | Both, if you can staff them | Salaries and turnover. Open biller roles took a median 67 days to fill |
| Generalist billing company | Ask whether reviews are in scope | Often professional claims only | Percentage of collections |
| Behavioral health specialty company | Usually in scope | Varies by company | Percentage of collections |
| EHR vendor RCM | Tied to that vendor platform | Within that platform only | Bundled with the software contract |
| Luxen | Owned daily from admission | Both, plus drug testing | 3% to 6% of collections, month to month |
To weigh options in your state, compare medical billing companies.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
H0008 and H0009 cover hospital inpatient detox, H0010 and H0011 residential addiction program inpatient detox, H0012 and H0013 residential program outpatient detox, and H0014 ambulatory detox. Facility claims add room and board revenue codes 0116 to 0156 by room type. Medicare pays hospital detox stays through MS-DRGs 894 to 897 instead of H codes.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee. For a detox program collecting $160,000 a month, that is $4,800 to $9,600. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in our billing reviews, or $12,640 a month for the same program.
Claims are usually being worked about 2 weeks after the BAA is signed; the median time from signed BAA to first claims worked was 9 business days. We start with open authorizations and days past the last authorized date, because those deadlines expire first. First recovered payments usually arrive in about 3 weeks.
Yes. We work inside your existing EHR or practice management system, with no migration. In our 2026 practice manager survey, 38% had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch.
Medicare groups an inpatient detox stay that ends against medical advice to MS-DRG 894, Alcohol, Drug Abuse or Dependence, Left AMA. Under the Medicare Benefit Policy Manual, the day of discharge is not counted, and a same-day admission and discharge counts as one day.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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