Although there are few specific codes for billing for buprenorphine treatment (nor for all of addiction medicine), most private health insurance companies are now covering the cost of treatment. PCPs have been successfully using standard evaluation and management outpatient billing codes for both the induction and maintenance stages of treatment.
Coding is either based on complexity of service or time, with four contributing components:
- physical exam
- complexity of decision-making
- contributing factors (eg: time)
In the event of an audit, the documentation for a single visit must stand alone, unless another record is specifically referenced.
The most commonly used CPT codes by Primary Care Physicians are as follows:
|Type of Visit||Code|
Comprehensive evaluation of new patient or established patient for suitableness for buprenorphine treatment
|New Patient: 99205
Established Patient: 99215
Any of the new patient evaluation and management (E/M) codes might be used for maintenance visits. Codes listed are in order of increasing length of time with patient and/or severity of the problems.
Psychiatric outpatient counseling code does not specify minutes.
Prolonged visit codes (99354, 99355) may also be added onto E/M codes for services that extend beyond the typical service time, with or without face-to-face patient contact. Time spent need not be continuous.
New Patient E/M: 99201-05
Established Patient E/M: 99211-15
Patient Consult: 99241-45
Psychiatric Outpatient Counseling: 99251-55
Any of these established patient E/M codes might be used for maintenance visits.
Counseling codes are commonly used to bill for maintenance visits, since since counseling and coordinating service with addiction specialists comprise the majority of these follow-up visits.
See the following page on counseling for more detailed information on how to bill for these visits.
Established Patient: 99211-15
The current ICD-10 code for opioid dependence is F11.2. The new code must be used by October 2015. The ICD-9 Code for opioid dependence was 304.0x. For the (x) use these classifications: 0=unspecified, 1=continuous, 2=episodic, 3=in remission.
Some private health insurers are developing standard billing codes for buprenorphine treatment services. For instance, Cigna tells clinicians to use the HCPCS code for "unspecified mental health care" for buprenorphine-related visits. The code is H0033 - Oral Medication Administration, Direct Observation. Cigna allows for approximately $300 reimbursement for the induction visit.