#1 Substance Abuse Disorder Billing Services in Baltimore, Maryland

#1 Substance Abuse Disorder Billing Services in Baltimore, Maryland

Treatment for SUD typically includes a combination of behavioral therapies, counseling, medication-assisted treatment (MAT), and long-term support. Despite the availability of effective treatments, a large portion of individuals with SUD do not receive the care they need. There are many barriers, such as stigma, lack of access to services, cost, and insufficient insurance coverage, that continue to prevent many from seeking help.

To support recovery and improve access to care in Baltimore, Maryland, investing in Substance Abuse Disorder Billing Services in Baltimore, Maryland becomes essential to assist both providers and patients. These services help providers in maintaining a healthy cash flow while reducing the administrative burden on internal staff. Better billing leads to better access to care, better outcomes, and a stronger healthcare system for everyone affected by substance abuse. 

SUD billing refers to the process of coding, submitting, and managing insurance claims for addiction treatment services. It involves using standardized coding systems such as ICD-10-CM for diagnoses and CPT/HCPCS codes for procedures and services delivered. In addition to these, providers must also comply with federal regulations such as HIPAA and 42 CFR Part 2, which are designed to protect the privacy of individuals undergoing addiction treatment. 

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Billing and Coding Guidelines for Substance Use Disorder 

Clean Claims. Quick Reimbursement. Better Recovery for every SUD Patient in Baltimore, Maryland

Coding Systems and Diagnosis Representation

When billing for SUD services, ICD-10-CM codes identify both the type of substance and the condition's nature, whether it involves abuse, dependence, withdrawal, or associated psychotic symptoms. The most common codes include:

• F10: Alcohol-related disorders
• F11: Opioid-related disorders
• F12: Cannabis-related disorders
• F13: Sedative, hypnotic, or anxiolytic-related disorders
• F14: Cocaine-related disorders
• F15: Other stimulant-related disorders
• F16: Hallucinogen-related disorders
• F17: Nicotine dependence
• F18: Inhalant-related disorders
• F19: Multiple/unspecified substance-related disorders

Every code is further detailed to reflect the patient's condition, such as withdrawal, intoxication, or remission. Using accurate diagnosis codes helps healthcare providers in Baltimore, Maryland ensure precise billing and minimize claim rejections.

CPT Code Selection 

The healthcare providers in Baltimore, Maryland use CPT codes to report specific clinical services provided during a patient visit. These codes include:

• 90791, 90792: Psychiatric diagnostic evaluations
• 90832, 90834, 90837: Individual psychotherapy sessions (30–60 minutes)
• 90846, 90847: Family therapy sessions
• 90853: Group therapy sessions
• 90863: Medication management with therapy
• 99408, 99409: Screening and brief interventions for substance use
• G0396, G0397: Short behavioral counseling for substance or alcohol use

Choosing the right code ensures that the services rendered are fully captured and reimbursed appropriately.

Bundled Codes for Office-Based SUD Treatment

CMS provides bundled G-codes for outpatient SUD care, particularly for alcohol and opioid use disorder treatments. These include:

• G2086: 70+ minutes of services in the initial calendar month
• G2087: 60+ minutes in each subsequent month
• G2088: Add-on code for every additional 30 minutes of services

These codes support integrated care plans that involve multiple services, often used by outpatient providers in Baltimore, Maryland.

Preventive Screening and Brief Intervention

CMS reimburses for early screening and brief behavioral interventions for patients at risk of substance misuse. These include:

• G0442: Annual alcohol misuse screening (15 minutes)
• G0443: Brief in-person counseling (15 minutes)
• G0396: Counseling sessions ranging from 15–30 minutes
• G0397: Counseling sessions over 30 minutes

The primary care clinics in Baltimore, Maryland often deliver these services, which must be properly documented with time spent and patient risk factors.

Safety Planning and Follow-Up Services

To prevent psychiatric emergencies or overdoses, CMS allows billing for:

• G0560: Development of a safety plan for individuals at risk of suicide or substance use crisis
• G0544: Follow-up contact after an overdose or critical event

These services should be conducted by licensed clinicians in Baltimore, Maryland, and include proper documentation per CMS policies.

Controlled Substance Monitoring & Lab Services

An effective treatment of substance use disorders, particularly those involving Medication-Assisted Treatment (MAT), includes drug testing. The providers in Baltimore, Maryland may use:

• CPT 80305–80307: Presumptive drug testing codes (limited to 12 tests per year per patient unless medically necessary)
• HCPCS G0480–G0483: Definitive testing codes based on the number of substances tested

These codes are essential for monitoring compliance in opioid treatment programs and office-based care settings.

Opioid Treatment Program (OTP) Billing 

The billing for OTP services is done using CMS G-codes that cover therapy, medication management, and coordination. The key codes include:

• G2067–G2083: Weekly bundled services for medications like methadone, buprenorphine, and naltrexone
• G2076: Comprehensive intake session, including audio-only telehealth when video isn’t accessible

The clinics in Baltimore, Maryland must track and document the medication type, dosage, therapy time, and take-home privileges weekly.

Social Determinants of Health (SDOH) Codes

CMS now supports billing for services that address non-clinical needs, such as food insecurity, housing instability, and transportation, through Community Health Integration (CHI) and Principal Illness Navigation (PIN) codes. However, only providers in Baltimore, Maryland are eligible to bill Evaluation and Management (E/M) codes, or psychologists can use these codes. The licensed Mental Health Counselors (MHCs) and Marriage and Family Therapists (MFTs) in Baltimore, Maryland are not authorized to bill for these services.

Expanded CMS Guidelines

Starting January 1, 2024, CMS permits MHCs and MFTs to enroll in Medicare and deliver SUD services in Baltimore, Maryland. To qualify, providers must hold a master’s or doctoral degree, possess a valid Maryland license, and have completed at least 3,000 hours of supervised clinical work. Reimbursement for these professionals is calculated at 80% of 75% of the standard Medicare fee schedule, less than that for other non-physician practitioners.

Are You Paying the Price for Inefficient SUD Billing Practices?

When SUD billing fails in Baltimore, Maryland, providers lose income and patients lose access.

Group Therapy Billing Inconsistencies

SUD programs in Baltimore, Maryland often deliver group therapy, but payer policies differ on how sessions should be billed. Inconsistent documentation on group size, duration, or session type can trigger denials. Providers must ensure alignment between clinical notes and billing requirements for group-based services.

MAT-Specific Coding Requirements

Billing for Medication-Assisted Treatment in Baltimore, Maryland involves unique HCPCS and CPT codes depending on the drug, dosage, and delivery method. Errors in coding injectable vs. oral medication or failing to include related counseling services often result in underpayment or denied claims.

Bundled vs. Unbundled Service Confusion

SUD programs in Baltimore, Maryland may unintentionally unbundle services that payers consider part of a package, such as combining assessments, drug testing, and therapy. This leads to compliance issues or payment denials. A clear understanding of bundled payment structures is essential in SUD billing.

Drug Testing Billing Restrictions

The frequent drug screenings are a key part of SUD care. But in Maryland, payer limitations on frequency, medical necessity, and code selection make billing challenging. Without precise documentation and justification, claims for urine drug screens may be flagged for overuse or denied altogether.

Struggling to keep up with complex SUD reimbursement rules in Baltimore, Maryland?

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Key Statistics

Denial Rate Without Expert Billing – 15–20%

Revenue Loss from In-House Billing – Up to 30%

SUD Services Delivered via Telehealth in Baltimore, Maryland – 45%

Claim Delay Due to Authorization Errors – 14–21 Days

Why Substance Abuse Treatment Providers in Baltimore, Maryland Trust 24/7 Medical Billing Services 

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Accurate Billing for Combined Services

Our billing specialists implement structured billing systems that properly account for multiple treatments like therapy, MAT, and counseling in Baltimore, Maryland. We ensure codes and modifiers are applied accurately to reduce claim rejections and maintain compliance with payer regulations.

Payer Education and Contract Support

Our team supports providers in educating payers in Maryland about the medical complexity of SUD through custom reports and data-driven presentations. We also assist in negotiating better contract terms that reflect the true value of long-term addiction treatment.

Automated Utilization Review Management

24/7 Medical Billing Services integrates EHR systems with payer portals for automated claims processing. Our team tracks deadlines, compiles progress updates, and ensures clinical documentation is ready for each phase of the treatment cycle.

Telehealth-Compliant Billing Setup

Our professionals configure telehealth billing systems to meet payer and Maryland-specific rules, including the correct use of modifiers and POS codes. We also guide providers in meeting HIPAA and documentation requirements for virtual SUD treatment services.

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Why Choose 24/7 Medical Billing Services for SUD Billing in Baltimore, Maryland?

24/7 Medical Billing Services helps SUD providers in Baltimore, Maryland scale operations without increasing internal workload. Our agile billing model adapts to seasonal fluctuations, census changes, and new service lines. We offer full support for documentation compliance, payer-specific guidelines, and audit preparedness to help you remain fully compliant at every stage. Outsource SUD Billing Services Provider in Baltimore, Maryland to stay audit-ready, revenue-strong, and focused on patient recovery, not paperwork.

Built-In Scalability

Our flexible team adjusts to your growth and helps you manage new locations, programs, or patient surges without delays. As a result, providers in Baltimore, Maryland can avoid staffing gaps, onboarding delays, and administrative burdens by leveraging our flexible, always-ready billing capacity.

AR Management on Autopilot

As a top medical billing and coding company in Baltimore, Maryland, we follow up on aging claims within 5 business days and resolve denials efficiently. This proactive approach ensures consistent cash flow and supports financial stability for SUD centers in Baltimore, Maryland, even during high-volume or seasonal fluctuations in service demand.

Audit-Ready Compliance 

Our billing team maintains airtight documentation, payer policy updates, and regulatory alignment across all claims. This reduces audit risks for SUD practices in Baltimore, Maryland, and ensures compliance, security, and operational soundness, even during random payer reviews or government inspections.

Multi-Channel Support 

Our experts offer patient and provider support across phone, email, portal, and text, ensuring fast issue resolution. In Baltimore, Maryland, your staff and patients benefit from responsive, multi-lingual help that enhances satisfaction and minimizes billing-related disruptions to care delivery.

Keep Patient Recovery Moving with Reliable Billing in Baltimore, Maryland

Our SUD billing and coding support uninterrupted treatment by minimizing billing delays, reducing denials, and closing documentation gaps. 24/7 Medical Billing Services helps preserve patient access and improve overall care delivery from initial intake to long-term aftercare.

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FAQs

Is SUD billing allowed for LCSWs and LPCs in Baltimore, Maryland? 

Yes, if credentialed with the payer and authorized to bill independently.

Are drug screenings required for SUD billing compliance in Baltimore, Maryland?

Not always, but they support ongoing treatment necessity.

Are there limits on billing SUD therapy per week in Maryland?

It depends on payer-specific utilization guidelines.

Can I bill for a no-show appointment in Baltimore, Maryland?

Only if the payer policy and state guidelines permit billing for missed visits.

Can SUD services be billed retroactively in Baltimore, Maryland?

Yes, within the payer’s timely filing limits, usually 90–180 days from the date of service.