Commonly Used CPT codes - Primary Care

Description:

This is a table containing common CPT codes used by primary care physicians for buprenorphine treatment reimbursement.

Coding is either based on complexity of service or time, with four contributing components:

history
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
Assessment Visit: Comprehensive evaluation of new patient or established patient for suitableness for buprenorphine treatment	New Patient: 99205 Established Patient: 99215
Induction Visits: Any of the new patient evaluation and management 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. 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, 99202, 99203, 99204, 99205 Est. Patient E/M: 92211, 92212, 92213, 99214, 99215 Add-on Codes: 99354: 30-60 minutes 99355: each additional 30 minutes
Maintenance Visits: 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.	92211, 92212, 992213

Type of Visit

Code

Assessment Visit:
Comprehensive evaluation of new patient or established patient for suitableness for buprenorphine treatment

New Patient: 99205
Established Patient: 99215

Induction Visits:
Any of the new patient evaluation and management 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.

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, 99202, 99203, 99204, 99205

Est. Patient E/M: 92211, 92212, 92213, 99214, 99215

Add-on Codes: 99354: 30-60 minutes
99355: each additional 30 minutes

Maintenance Visits:
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.

92211, 92212, 992213

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.

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