Top-rated Substance Abuse Disorder Billing Services in Texas, TX

 

Top-rated Substance Abuse Disorder Billing Services in Texas, TX

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 Texas, TX 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 Texas, TX.

Make every claim count!
Talk to our SUD billing team today in Texas, TX!

 

Billing and Coding Guidelines for Substance Use Disorder 

Stronger Billing. Faster Payments. Better Care for every SUD Patient in Texas, TX

Coding Systems and Diagnosis Representation

In SUD billing, ICD-10-CM codes represent the specific substance involved and the nature of the disorder, such as abuse, dependence, withdrawal, or psychotic episodes. These range from:

• 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

Each code is further specified by use patterns (e.g., with withdrawal, with intoxication, or in remission). Proper coding helps providers in Texas, TX reduce claim errors and improve accuracy.

CPT Code Selection 

CPT codes are widely used by providers in Texas, TX for documenting the exact clinical services provided during an encounter. These codes include:

• 90791, 90792: Psychiatric diagnostic evaluations
• 90832, 90834, 90837: Individual psychotherapy (30–60 mins)
• 90846, 90847: Family therapy
• 90853: Group therapy
• 90863: Medication management in combinaton with therapy
• 99408, 99409: Alcohol or substance use screening and brief interventions
• G0396, G0397: Brief behavioral counseling for alcohol/substance use

Bundled Codes for Office-Based SUD Treatment

CMS offers bundled G-codes for comprehensive outpatient treatment, especially for opioid and alcohol use disorders:

• G2086: 70+ minutes in the first calendar month 
• G2087: 60+ minutes in subsequent months
• G2088: Add-on code for each additional 30 minutes beyond the above services

These are used for structured care plans and multiple service types delivered together in Texas, TX outpatient clinics.

Preventive Screening and Brief Intervention

CMS supports early identification and brief counseling interventions for at-risk individuals for alcohol or substance misuse:

• G0442: Annual screening (15 minutes)
• G0443: Brief face-to-face behavioral counseling (15 minutes)
• G0396: Short counselling sessions (15–30 minutes)
• G0397: Extended counseling sessions (more than 30 minutes)

These services are often performed in primary care settings in Texas, TX, and require proper documentation of risk factors and time spent.

Safety Planning and Follow-Up Services

To reduce overdose risk or psychiatric crises, Medicare allows billing for:

• G0560: Safety planning for patients at risk of suicide or substance use crisis
• G0544: Follow-up contact intervention after overdose or crisis-related event

These services must be documented and performed by licensed professionals in Texas, TX, following CMS guidelines.

Controlled Substance Monitoring & Lab Services

When managing addiction treatment, especially MAT (Medication-Assisted Treatment), providers often use:

• CPT 80305–80307: Drug testing codes (presumptive)

Medicare limits to 12 tests per patient/year unless medically justified

• HCPCS G0480–G0483: Definitive drug testing based on substance count

These services are essential in Texas, TX opioid treatment programs and office-based care.

Opioid Treatment Program (OTP) Billing 

OTP services are billed using G codes and include medication, therapy, and care coordination:

• G2067–G2083: Cover weekly bundled services for methadone, buprenorphine, and naltrexone
• G2076: Intake session (including audio-only visits if video is unavailable)

Clinics in Texas, TX must document dosage, take-home status, and therapy time each week.

Social Determinants of Health (SDOH) Codes

CMS has added new codes to support services that help patients with needs like housing, food, and transportation. These include Community Health Integration (CHI) and Principal Illness Navigation (PIN). However, only providers in Texas, TX who can bill Evaluation and Management (E/M) codes or psychologists can use these codes. MHCs and MFTs in Texas, TX are not allowed to bill for these services.

Expanded CMS Guidelines

As of January 1, 2024, CMS allows Mental Health Counselors (MHCs) and Marriage and Family Therapists (MFTs) to enroll in Medicare and provide SUD treatment in Texas, TX. They must have a master’s or doctoral degree, a valid Texas license, and at least 3,000 hours of supervised clinical experience. These providers are reimbursed at 80% of 75% of the Medicare fee schedule, which is lower than what other non-physician providers receive.

 

Is Inaccurate SUD Billing Putting Your Reimbursements at Risk?

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

Coordination of Benefits Confusion

SUD patients in Texas, TX 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 Texas, TX 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 Texas, TX 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 Texas, TX, 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 Texas, TX draining your team?

It is Time to Speak with our Experts!

Key Statistics

Denial Rate Without Expert Billing – 15–20%

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

SUD Services Delivered via Telehealth in Texas, TX – 45%

Claim Delay Due to Authorization Errors – 14–21 Days

 

Why Substance Abuse Treatment Providers in Texas, TX Trust 24/7 Medical Billing Services 

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

Documentation Support and Review

Our experts guide providers in Texas, TX 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 Texas, TX, 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 Texas, TX 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.

Say goodbye to claim chaos!

Partner with SUD billing professionals who deliver results!!

100% Compliant Billing for Critical Behavioral Health Treatments!

 

Why Choose 24/7 Medical Billing Services for SUD Billing in Texas, TX?

24/7 Medical Billing Services specializes in handling the complex and evolving requirements of SUD billing in Texas, TX. Our solutions integrate cutting-edge RCM tools, denial tracking, HIPAA-compliant technology, and many more. This makes us the trusted outsourced partner for addiction treatment providers. Outsource SUD Billing Services Provider in Texas, TX to improve operational efficiency and elevate your billing performance while providing substance abuse disorder treatment services.

Real-Time Claim Tracking

You can track every claim from submission to payment with real-time dashboards and alerts. Our SUD billers and coders in Texas, TX offer transparency into delays, denials, and payer-specific issues. This allows for timely interventions and strategic decision-making based on up-to-the-minute billing performance metrics.

High First-Pass Rate

Our 95%+ clean claims rate means faster approvals and fewer rejections. We use automation, scrubbers, and compliance checkpoints to ensure your claims are accurate, payer-ready, and error-free. This helps SUD programs in Texas, TX avoid revenue loss and time-consuming rework.

Transparent Reporting 

Our experts in Texas, TX provide access to detailed, customizable reports on collections, AR, denials, and payer trends. As a result, you can receive regular insights into performance, identifying bottlenecks and opportunities for improvement. This empowers you to take control of your financial data and optimize your revenue cycle.

Technology-Powered Efficiency 

As a top medical billing and coding services company in Texas, TX, we deploy robotic process automation, HL7 integration, and EHR-friendly billing workflows. You can benefit from seamless billing processes, fewer manual errors, and greater operational efficiency. All this is possible without the need to purchase or manage complex, expensive billing software themselves.

99.99% Clean Claims and 100% Payouts for SUD Services in Texas, TX

Our SUD billing experts ensure precise coding and complete documentation to reduce denials and speed up approvals. Trust our billing team to keep your revenue flowing and your focus on treating SUD patients.

Speak with our SUD Billing Experts 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 Texas, TX?

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 Texas, TX must give good-faith estimates to uninsured/self-pay patients.

How do I handle pre-authorization delays for SUD treatment in Texas, TX?

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