# Alcohol and Drug Abuse Residential Treatment Facility



## meg006 (Jul 10, 2017)

I work for a new facility that provides individual and group counseling for substance abuse and co-occurring disorders.  There are medical and behavioral health staff whom provide treatment.   It is a 24-hour facility (not a hospital) and the length of stay varies from 30-90 days.   

I am looking to connect with others who are familiar with billing for these types of facilities.  What is the appropriate code to use for billing the facility daily charge?  The code range I am looking at is H0010 – H0019.  I also see revenue codes 1002 (Residential Treatment Chemical Dependency) and 906 (Behavioral Health Treatments/Services Chemical Dependency).  

Any assistance would be greatly appreciated.


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## Rmarcushishouse (Jul 10, 2017)

Do you have specific questions?
Each hcpcs represents a different loc. What LOC are you providing?


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## meg006 (Jul 11, 2017)

Our LOC is 3.5.  I am looking for a code to bill the facility daily rate that includes room and board.


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## wdrega (Jul 13, 2017)

meg006 said:


> Our LOC is 3.5.  I am looking for a code to bill the facility daily rate that includes room and board.



I bill for a dual dx 3.5-1 facility. Based on our licensure and the services we provide we use the following:

RTC = Rev: 1002 HCPC: H0019 (I've seen others also use H2036 but the insurance companies primary look for the Rev code.)
PHP = Rev: 0912 HCPC: H2036 (we have one insurance company that wants H0015)
IOP = Rev: 0906 HCPC: H0015
OP Group = Rev: 0915 HCPC: H0005
OP FTF = Rev:0914 HCPC:H004 


I hope this helps.


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## meg006 (Jul 14, 2017)

Very helpful. Thank you wdrega!

I am so new at residential treatment.  Do you know of any training resources or networking groups for these types of facilities?


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## wdrega (Jul 14, 2017)

meg006 said:


> Very helpful. Thank you wdrega!
> 
> I am so new at residential treatment.  Do you know of any training resources or networking groups for these types of facilities?




I feel you. I moved from Community BH to a private residential facility about a little over a year ago.  I had to build our billing department from the ground up and I would have loved a networking group or in-pt training option.  Most of my resources have been found between coding books and Google lol. 

My advice, If you don't have anyone in your department with more experience, or if you are building from the ground up, hire a consultant. We ended up hiring a consultant because the Admin at the time was convinced that we could use different codes to get paid more. She was able to confirm that I was on the right track and make a few suggestions about our daily processes. Short-term it was invaluable. 

If you do the pre-auths make sure you read over everyone's LOC criteria, you need to know things like what a nasty beast Optum is compared to Aetna. Many of the care managers that do the initial setup for the auth were really helpful when I first started, they were able to confirm which rev codes I should be using for each LOC.  The HCPC codes for Tx were easy enough for me, but we also operate our own lab. The lab was a beast to figure out, mainly because it was new and getting ahold of the lab person to clarify the specifics of our testing was tough. Then half the insurance companies wanted HCPC and the other wanted CPT...

Ok I'm rambling now. PM me if you have better luck finding a BH group, or if you just want to swap horror stories. 

Have a great day!


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## k.ellias (Jul 14, 2017)

I'm a new coder at a small clinic where we offer outpatient AODA and behavioral health visits as well.  I am having issues with our AODA providers refusing or "forgetting" to do the prior authorizations; therefore, nothing is getting paid.  They are trying to find codes to use where they don't have to do prior authorizations, which I don't think is right.  

So, I wanted to ask if anyone has experience with coding for AODA and Day Treatment? 

H2012 (HN) is being used for Day Treatment
H0005 (HN) is being used for small group sessions that last 1 hour. 
H0022 (HN) is being used for individual sessions 

Please let me know your thoughts/suggestions.  

Thank you in advance!!


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## wdrega (Jul 14, 2017)

k.ellias said:


> I'm a new coder at a small clinic where we offer outpatient AODA and behavioral health visits as well.  I am having issues with our AODA providers refusing or "forgetting" to do the prior authorizations; therefore, nothing is getting paid.  They are trying to find codes to use where they don't have to do prior authorizations, which I don't think is right.
> 
> So, I wanted to ask if anyone has experience with coding for AODA and Day Treatment?
> 
> ...




What LOC are they providing? 
How many hours is your Day Tx?
H0022 is a intervention service. You probably want H0004 for the individual sessions.


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## meg006 (Jul 14, 2017)

wdrega said:


> I feel you. I moved from Community BH to a private residential facility about a little over a year ago.  I had to build our billing department from the ground up and I would have loved a networking group or in-pt training option.  Most of my resources have been found between coding books and Google lol.
> 
> My advice, If you don't have anyone in your department with more experience, or if you are building from the ground up, hire a consultant. We ended up hiring a consultant because the Admin at the time was convinced that we could use different codes to get paid more. She was able to confirm that I was on the right track and make a few suggestions about our daily processes. Short-term it was invaluable.
> 
> ...



So glad I am not alone on this!  We are a new facility and starting from scratch.  My background is outpatient Medical/Dental/Behavioral Health non-profit clinic type setting.  Love my code books!!...But the codes are not so straightforward for these types of services/facilities.  Google always leads me to Magellan, whom seems to be a leader in Behavioral Health.  Not sure if other insurers follow the same guidelines or if each insurance does their own thing..?  Hope that's not the case.  Thanks so much for the tips!  I might PM you later.


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## k.ellias (Jul 17, 2017)

wdrega said:


> What LOC are they providing?
> How many hours is your Day Tx?
> H0022 is a intervention service. You probably want H0004 for the individual sessions.




Thanks for replying!

Our Day Tx is 3 hours a day, 4 days a week. 
I'm not sure what you mean by "LOC"?
Is there somewhere that elaborates more on what exactly the H-Codes are? 

-Kellie


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## EMHaven (Jul 25, 2017)

*Help!!*

Hi!

I am also working at starting up an organization that consists of 3 houses (2 RTC and 1 for Detox) and an outpatient facility. I had previous experience in outpatient substance facility but was new the whole RTC portion. I've doing it for the last 8 months or so, and while I think I have a lot figured out, I know there's much more to know! I'd love to bounce thoughts and ideas off each other. 

1.) I have having a difficult time getting proper, or even any, reimbursement from Blue Shield of CA for my RTC w/ detox treatment, even though the treatment is authorized. 

2.) Our medical consultant doesn't bill insurance for his MD visits with our RTC clients, but obviously bills the facility. Can we, the facility, bill for his services under our Tax ID but with MD NPI? I think one of us should be billing for those visits since they are not inclusive in our billing codes. 

I'm sure there's more!! Mainly right now I am having issues with Blue Shield. The care manager is giving us authorization for a RTC with Detox but the authorization just has a HCPCS code, not a revenue code. I would normally bill our detox with a 0126 revenue code but all of those claims are being denied as "all levels of detox must be done in a hospital setting". So, is the care manager giving me null and void authorizations or is there a different revenue code to use for these services. I know once it's RTC, I use revenue code 1002 and that seems to work ok, although the reimbursement rate is low. But I can't figure out the detox portion. 

Thanks for any advice!! My email is emacri0930@gmail.com


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## pam@gookomisendaad.com (Jul 26, 2018)

meg006 said:


> So glad I am not alone on this!  We are a new facility and starting from scratch.  My background is outpatient Medical/Dental/Behavioral Health non-profit clinic type setting.  Love my code books!!...But the codes are not so straightforward for these types of services/facilities.  Google always leads me to Magellan, whom seems to be a leader in Behavioral Health.  Not sure if other insurers follow the same guidelines or if each insurance does their own thing..?  Hope that's not the case.  Thanks so much for the tips!  I might PM you later.



Also Glad to hear i am not alone in this new and upcoming process. We are a CBRF 90 day residential treatment faciltiy. I am looking for insight to billing counselors MH and AODA.
We are a FQHC but bill R&B seperately from counselling. I am billing H2036 for the daily bed is that the best code out there?


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## lpatrick1313 (Oct 23, 2020)

What POS are you using for Partial Hospitalization?


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## justsarahk@gmail.com (Dec 24, 2020)

lpatrick1313 said:


> What POS are you using for Partial Hospitalization?


Php is billed on a ub 04 so no pos just bill type 89x


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## midwestbilling9098 (Mar 16, 2021)

PHP


justsarahk@gmail.com said:


> Php is billed on a ub 04 so no pos just bill type 89x


PHP TOB is now 89X not 13X? Thank you


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## crmills08 (Mar 17, 2021)

It's been a long time so I'm unsure anyone will answer but is it OK to bill RTC & Individual sessions on the same date... Could I bill H0017 or H0018 with 90834 or 90837?


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## Nolan68 (May 18, 2021)

Hi,
You folks seem to really know your stuff. I was wondering if any of you would know what services are bundled into H0001. I work for an OTP and this is my first time doing so after coding for the military for almost 10 years. I could really use some help.
michelenolan68@yahoo.com
Thank you!


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