Billing for Office-Based Opioid Treatment

Physicians who wish to go through a patient's health insurance, as opposed to fee for service, often have questions on how the various services involved in buprenorphine treatment should be billed. Office-based buprenorphine treatment (OBOT) should be considered to be a part of regular medical care. Treatment is provided by regular doctors in regular settings and, accordingly, billing procedures for OBOT should be considered regular as well.

This document provides commonly used Current Procedural Terminology (CPT) codes for buprenorphine treatment in the following areas:

• Commonly Used CPT Codes - Primary Care
• Commonly Used CPT Codes for Counseling - Primary Care
• Commonly Used CPT Codes for Buprenorphine Treatment - Psychiatrists
• Medicaid Screening and Brief Intervention Codes

Commonly Used CPT Codes- Primary Care

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. Primary Care Physicians (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: history, physical exam, complexity of decision-making, and contributing factors (e.g., 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:

The ICD-9 Code for opioid dependence is 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.

Commonly Used CPT Codes for Counseling- Primary Care

Counseling and coordinating service with addiction specialists will be a large portion of maintenance visits. PCPs can provide and bill for counseling without conducting a review of systems, and should use Counseling codes in place of E/M codes (92211-15). Documentation for a counseling visit should include: total visit time, time spent counseling or coordinating care (must be face-to-face), and the nature/content of the counseling.

The determining factor for when PCPs can use counseling time rather than complexity in a visit is that counseling or coordination of care must take up more than 50% of of the total visit time. Coding is then based on the total visit time, not just the time spent counseling or coordinating care. A statement such as the following serves as documentation of time spent:

"A total of ___ minutes of a _____ minute visit was spent counseling the patient about _____. "

Commonly Used CPT Codes for Buprenorphine Treatment - Psychiatrists

For psychiatrists, CPT codes for buprenorphine treatment are time-based.

The most commonly used CPT codes by Psychiatrists are as follows:

The Group Therapy code is an appropriate code to use when buprenorphine treatment is provided in an Intensive Outpatient Services program.

Medicaid Screening and Brief Intervention Codes

New Screening and Brief Intervention (SBI) codes are currently in place in 9 states. These codes, H0049 - Alcohol and Drug Screening, and H0050 - Brief Intervention, enable physicians to be reimbursed for screening Medicaid-eligible patients for substance abuse.

The states with the codes in place thus far are: Iowa, Maryland, Minnesota, Montana, Oklahoma, Oregon, Tennessee, Virginia, and Washington. Wisconsin provides SBI as part of a package for pregnant women.

Note for Medicaid licensed providers who live in states where Medicaid pays for buprenorphine treatment: charging cash for buprenorphine treatment is illegal and state attorney generals have been investigating such practices.