Billing and collections for detox, residential, PHP, IOP, outpatient counseling and opioid treatment programs, done inside the EHR you already run.
Addiction treatment revenue is lost one day at a time: a residential stay runs past its review date, an IOP week goes out on the wrong H code, or an OTP intake never reaches the claim. Missing or invalid prior authorization caused 17% of denials in the Luxen claim audit of 61,400 claims. Luxen runs benefits checks, authorization tracking, coding and appeals so every level of care is paid for the days delivered.
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Substance abuse billing services manage benefits checks, authorizations, coding, claims and appeals for detox, residential, PHP, IOP, outpatient and opioid treatment programs. They bill H codes, UB-04 revenue codes and Medicare bundles; in 2026 Medicare pays a national $277.29 for a weekly methadone bundle (G2067) before locality adjustment.
We bill across the whole substance use disorder continuum, and each setting bills differently.
Service lines we bill alongside treatment, often on the same claim: presumptive and definitive drug testing, case management (H0006), peer support (H0038), family counseling (T1006) and telehealth.
Most lost addiction treatment revenue is a day nobody authorized, an add-on nobody coded, or a per diem paid below contract, which is why eligibility and prior authorization work starts before admission. Dollar figures are 2026 Medicare national OTP rates before locality adjustment, or Luxen claim audit data.
Addiction treatment uses three code sets: HCPCS H and S codes for programs, CPT for professional services, and UB-04 revenue codes for facility claims. Which one a payer expects depends on the level of care, claim form and state. Our certified medical coding team maps each payer before the first claim.
Facility programs bill the UB-04 (837I) with a revenue code and, for most payers, a HCPCS code on the same line: 1002 residential treatment, chemical dependency; 0906 intensive outpatient, chemical dependency; 0944 drug rehabilitation; 0945 alcohol rehabilitation; 0912 and 0913 partial hospitalization; 0116 or 0126 detox room and board. Practices bill counseling on the CMS-1500 (837P).
The ASAM Criteria, 4th edition (2023) folded withdrawal management into the main levels: 3.2-WM maps to 3.5 and 1-WM to 1.7. Confirm which edition each payer's utilization review uses.
Montana Medicaid's SUD fee schedule pays H0015 as ASAM 2.1 intensive outpatient per week and uses H0012 for SUD partial hospitalization at ASAM 2.5, while the national H0012 descriptor is outpatient sub-acute detoxification. See Montana medical billing rules. In New York, fully insured commercial plans must pay in-network OASAS-certified outpatient programs no less than the Medicaid rate for policies issued or renewed from January 1, 2025. See New York behavioral health billing.
Medicare pays OTPs weekly bundles covering medication, dispensing, counseling, therapy and toxicology testing. Rates are 2026 national CMS figures before locality adjustment.
Physicians and non-physician practitioners treating any SUD in the office bill G2086 for the first month (at least 70 minutes), G2087 for later months (at least 60 minutes) and G2088 for each additional 30 minutes beyond the first 120 minutes.
CPT 99408 covers structured alcohol and/or substance screening, such as AUDIT or DAST, with brief intervention for 15 to 30 minutes; 99409 covers more than 30 minutes. Medicare uses G0396 and G0397 for the same time bands.
Since January 1, 2024, Medicare covers intensive outpatient services in hospital outpatient departments, CMHCs, FQHCs, RHCs and OTPs, with certification that the patient needs a minimum of 9 hours per week, renewed at least every 60 days. Partial hospitalization needs a minimum of 20 hours per week. Addiction counselors who meet mental health counselor requirements can enroll as MHCs, paid at 75% of the clinical psychologist rate; enrollment is part of our credentialing service. Under the SUPPORT Act, telehealth for SUD treatment has had no geographic or originating site limits, including the home, since July 1, 2019.
The rule published February 16, 2024 allows a single consent for all future uses and disclosures for treatment, payment and health care operations and states that segregating Part 2 records is not required. Programs had to comply by February 16, 2026, the day HHS began accepting Part 2 complaints and breach reports.
The Eliminating Kickbacks in Recovery Act (18 U.S.C. 220) makes paying or receiving remuneration for referrals to recovery homes, clinical treatment facilities or laboratories a federal crime, with a fine of not more than $200,000, imprisonment of not more than 10 years, or both, for each occurrence.
Medicare pays definitive drug testing with G0480 to G0483, tiered by 1 to 7, 8 to 14, 15 to 21 and 22 or more drug classes. Palmetto GBA's LCD L35724 allows no more than 3 presumptive tests per rolling 7 days and 1 definitive test per rolling 7 days during the first 30 days of abstinence, with different limits after that.
After the sober living fraud scheme it announced in May 2023, Arizona's Medicaid agency had 266 providers under payment suspension as of December 31, 2024. See our Arizona medical billing guide.
The 2024 final rule states that segregating or segmenting Part 2 records is not required, and one consent can cover all future treatment, payment and health care operations disclosures (HHS Part 2 fact sheet). Payer-specific consent forms hold claims whenever coverage changes.
HCPCS publishes one descriptor, but state Medicaid programs set units and levels: Montana pays H0012 as weekly SUD partial hospitalization (Montana Medicaid SUD fee schedule). A unit or level mismatch denies the whole line. Coding and modifier errors caused 21% of denials in the Luxen claim audit.
Since January 1, 2024, addiction counselors who meet all mental health counselor requirements can enroll in Medicare as MHCs (CMS MFT and MHC guidance). Unenrolled counselors bill that time to nobody, and credentialing lapses delayed payment for 1 in 12 providers added in the prior year (Luxen billing reviews).
Employer group health plans must give claimants at least 180 days after a denial notice to appeal (29 CFR 2560.503-1). Appeals filed by Luxen were overturned 68% of the time (Luxen client data).
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.
We work inside the systems your program already runs. No migration and no new system for clinicians.
We sign the BAA before access and bill from the charts, census and consents your team already maintains.
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
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
We had $184,000 sitting beyond 90 days, but the accounts were not separated by authorization, coding, and documentation issues. Luxen rebuilt the work queues and recovered $112,700 within five months.
Executive Director, multi-location substance use treatment program
Attendance records, clinician notes, and toxicology results were reaching billing at different times. Luxen created one daily reconciliation process, reducing our average claim-submission lag from nine days to two.
Revenue Cycle Director, outpatient recovery network
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Benchmarks come from Luxen billing reviews (410 practice billing reviews, Jan 2025 to Jun 2026) and the Luxen Practice Manager Survey 2026 (286 practice managers, March 2026).
| KPI | Why it matters in SUD billing | Luxen benchmark |
|---|---|---|
| AR past 90 days | Per diem claims carry large balances | 27% of total AR sat past 90 days in the average practice reviewed |
| Denial concentration | A few authorization rules drive most losses | The top three denial reasons accounted for 58% of denied dollars in the average practice |
| Denials never worked | Each unworked per diem denial is a full day of care | 19% of denied claims were never reworked or appealed |
| Ownership | Authorizations and appeals need one owner | 42% of practice managers said nobody owns denial follow-up full time |
Practices that reviewed AR ageing monthly carried 12 fewer days in AR. Our denial and AR recovery team reports these KPIs monthly by level of care and payer.
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, depending on levels of care, claim volume and authorization workload. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Residential (UB-04 per diem) | $80,000 | $2,400 | $4,800 |
| PHP, IOP and outpatient | $45,000 | $1,350 | $2,700 |
| Opioid treatment program | $25,000 | $750 | $1,500 |
| Total | $150,000 | $4,500 | $9,000 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $11,850 (7.9% of collections) | $4,500 to $9,000 |
| Annual | $142,200 | $54,000 to $108,000 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews).
| Partner type | SUD code depth | Authorization tracking | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Often shared with admissions | Built by your staff | Payroll and turnover |
| Generalist billing company | CPT-focused | Often not included | Standard aging reports | Often annual terms |
| Specialty SUD billing company | Per diem and H code experience | Sometimes a separate UR fee | Varies | Varies, some charge setup fees |
| EHR vendor RCM | Tied to vendor templates | Limited | Inside the vendor platform | Bundled with software |
| Luxen | Certified coders for H, G and revenue codes | Included | Monthly denials and AR by level of care | Month to month, 30 days notice |
Compare medical billing companies on these points, or see what full-service medical billing covers.
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.
S9480 is intensive outpatient psychiatric services, per diem, a mental health code. H0015 is alcohol and/or drug intensive outpatient for a program running at least 3 hours a day and at least 3 days a week. Neither is payable by Medicare, and state Medicaid sets the H0015 unit. For substance use IOP billed per diem to a commercial payer, S9475 is the SUD-specific code.
Luxen charges 3% to 6% of collections, depending on levels of care and authorization workload. For a program collecting $150,000 a month, that is $4,500 to $9,000. Fully loaded in-house billing cost 7.9% of collections for practices under $2M in Luxen billing reviews.
About 2 weeks from signed BAA to working claims; median time from signed BAA to first claims worked was 9 business days across Luxen clients. We start with open authorizations and the oldest recoverable claims, so first recovered payments arrive in about 3 weeks. There is no migration, setup fee or exit fee.
Yes. We work inside the EHR and practice management system you already use, including Kipu, Sunwave, Lightning Step, ZenCharts and Qualifacts. We sign a BAA before access and follow your 42 CFR Part 2 consent process.
Yes. Since January 1, 2024, addiction counselors and alcohol and drug counselors who meet all MHC requirements can enroll in Medicare as MHCs, paid at 75% of the clinical psychologist rate.
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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