CPT and ICD Codes Related to Buprenorphine Treatment
Ask about patient insurance during the first visit even if they do not plan to file for office visits. Buprenorphine may be covered as a pharmacy benefit. However, some patients may wish not to file insurance, as it is recorded on their permanent health record.
There are few specific codes for billing for buprenorphine treatment. Primary care physicians have been successfully using standard evaluation and management outpatient billing codes for both induction and maintenance treatment stages.
Coding is either based on complexity of service or time, with four contributing components:
- Physical exam
- Complexity of decision-making
- 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:
|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. 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 code, ICD-10, for opioid related disorders is F11. This code replaces the old ICD-9 codes. The ICD-10 code must be used as of October 1, 2015. The ICD-9 Code for opioid use disorder was 304.0x. The "x" refers to these classifications: 0=unspecified, 1=continuous, 2=episodic, 3=in remission.
Some private health insurers have developed standard billing codes for buprenorphine treatment services. For instance, the Healthcare Common Procedure Coding System (HCPCS) code for "Oral medication administration, direct observation" is H0033. Be sure to check with individual insurers, as they may have different policies.