Top-rated Substance Abuse Disorder Billing Services in Berkeley, California

Top-rated Substance Abuse Disorder Billing Services in Berkeley, California

According to the National Survey on Drug Use and Health, more than 46 million people aged 12 or older had a substance use disorder. This includes alcohol use disorder and misuse of other substances such as cocaine, cannabis, and prescription medications. The opioid epidemic continues to be a major contributor to overdose deaths, with synthetic opioids like fentanyl involved in a significant percentage of cases.

As SUD continues to impact millions across the United States, the need for accurate and efficient Substance Abuse Disorder Billing Services in Berkeley, California has become increasingly critical. With a growing demand for SUD treatment services, including counseling, behavioral therapies, medication-assisted treatment (MAT), and telehealth sessions, healthcare providers are under pressure to seek expert advice. 

Outsourced SUD billing services involve the full cycle of claims management. It ranges from patient eligibility verification and coding to claim submission, denial management, and payment posting. Outsourced billing teams are well-versed in ICD-10-CM diagnostic codes for substance use disorders and CPT/HCPCS codes used to bill for SUD treatment services in Berkeley, California.

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Billing and Coding Guidelines for Substance Use Disorder 

Clean Claims. Quick Reimbursement. Better Recovery for every SUD Patient in Berkeley, California

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 Berkeley, California ensure precise billing and minimize claim rejections.

CPT Code Selection 

The healthcare providers in Berkeley, California 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 Berkeley, California.

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 Berkeley, California 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 Berkeley, California, 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 Berkeley, California 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 Berkeley, California 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 Berkeley, California 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 Berkeley, California 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 Berkeley, California. To qualify, providers must hold a master’s or doctoral degree, possess a valid California 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.

Is Inaccurate SUD Billing Putting Your Reimbursements at Risk?

Every denied claim and coding error in Berkeley, California means lost revenue for providers and delayed care for patients.

Coordination of Benefits Confusion

SUD patients in Berkeley, California often have multiple or changing insurance policies. Identifying the correct primary payer is crucial but complicated. Without proper coordination, claims are delayed, duplicated, or denied. This can disrupt payments and complicate financial operations for providers.

High Claim Denial Rates

As compared to other services, SUD billing in Berkeley, California faces higher denial rates. These stem from inconsistent documentation, authorization issues, and payer-specific rules. Without targeted billing strategies, providers risk losing a large portion of legitimate reimbursements.

Lack of Specialized Billing Expertise

Many facilities in Berkeley, California rely on general billing staff unfamiliar with SUD coding and payer expectations. This often leads to preventable errors and lost income. Outsourcing SUD billing and coding to experts can help close these gaps and capture missed revenue.

Inconsistent Payer Requirements

In Berkeley, California, SUD billing is complicated by varying payer rules for services, documentation, authorizations, and billing codes. Each insurer may define medical necessity differently or limit covered treatments. It is important to deal with these inconsistencies, which require ongoing payer research to avoid denials and delayed payments.

Is your SUD billing in Berkeley, California draining your team?

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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 Berkeley, California – 45%

Claim Delay Due to Authorization Errors – 14–21 Days

Why Substance Abuse Treatment Providers in Berkeley, California Trust 24/7 Medical Billing Services 

Experience Faster Payments and Fewer Errors with the Best Outsourcing SUD Billing and Coding Company in Berkeley, California!

Documentation Support and Review

Our experts guide providers in Berkeley, California in maintaining treatment plans, progress notes, and session details that meet medical necessity standards. The team will conduct pre-submission reviews to ensure the records fully support billed services and withstand audit scrutiny.

Compassionate Patient Financial Communications

24/7 Medical Billing Services offers tailored financial communication strategies for providers in Berkeley, California, helping patients understand their cost responsibility. We help design supportive payment plans, automated billing options, and transparent cost estimates to maintain trust throughout the recovery process.

Compliant Billing Under 42 CFR Part 2

Our specialists are trained in 42 CFR Part 2 and ensure all billing and documentation practices in Berkeley, California comply with federal confidentiality requirements. This helps providers balance patient privacy with billing requirements by applying secure systems and compliant coding protocols.

Audit-Proof Clinical Documentation Practices

We assist providers with structured documentation workflows that address common gaps, such as missing notes or diagnosis details. Our team reviews clinical records before submission to reduce the risk of denials and ensure complete payer-required documentation is in place.

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100% Compliant Billing for Critical Behavioral Health Treatments!

Why Choose 24/7 Medical Billing Services for SUD Billing in Berkeley, California?

24/7 Medical Billing Services offers specialized billing solutions for SUD treatment providers in Berkeley, California. Our dedicated team understands the sensitive nature and billing complexity of SUD care, including the unique payer rules, codes, and compliance demands that make in-house billing difficult. With our deep industry knowledge, we help providers eliminate denials, improve reimbursements, and maintain compliance. You can outsource SUD Billing Services Provider in Berkeley, California to meet your unique clinical and compliance requirements.

Fast-Track Payments

When SUD billing is accurately coded and documented, up to 30% of claims are eligible for faster reimbursement. Our team uses intelligent claim tracking systems and payer-specific rules to reduce delays. This helps your practice in Berkeley, California to maintain a stable cash flow.

End-to-End Expertise

As a top medical billing and coding company  in Berkeley, California, we manage every stage of the billing process, from initial patient intake to post-treatment follow-up. Our billing professionals are trained to handle detox, MAT, outpatient care, and therapy claims with unmatched precision.

5-Day Follow-Up Promise 

Our experts guarantee follow-up on all accounts receivable within 5 business days. This disciplined approach guarantees providers in Berkeley, California to minimize delays, shortens your revenue cycle, and keeps your cash flow consistent so you can stay focused on patient care.

Unmatched Data Security 

Your data is protected with HIPAA-compliant systems and adherence to 42 CFR Part 2 in California. Our professionals use advanced encryption, secure submissions, and role-based access to safeguard sensitive SUD patient information at every stage of the billing cycle.

Maximize Reimbursements for Every Stage of Recovery Care in Berkeley, California

Our SUD billing experts ensure accurate claims, reduced denials, and faster payments, so you can focus on helping patients heal. We handle it all with 24/7 claim tracking and follow-up from intake to aftercare.

Schedule Your Free SUD Billing Audit Today

FAQs

What is the billing code for crisis intervention in SUD?

Use H2011 or 90839, depending on the provider and setting.

Do SUD services require a DSM-5 diagnosis in Berkeley, California?

Most payers require DSM-5 alignment with ICD-10 coding.

Can I bill SUD services without a treatment plan?

A signed and updated treatment plan is typically required for billing approval.

What is the impact of the No Surprises Act on SUD billing?

Out-of-network providers in Berkeley, California must give good-faith estimates to uninsured/self-pay patients.

How do I handle pre-authorization delays for SUD treatment in Berkeley, California?

Start care if urgent and document it, and submit retroactive auth if the payer allows.