# Substance abuse IOP-PLEASE HELP!



## abalkevitch (Sep 15, 2011)

I work at an IP/OP psych facility, and we do Intensive Outpatient Substance Abuse programs. We have been billing this for Medicare on a UB with rev code 906 and HCPCS 
H0015, but they are all being rejected for incorrect HCPCS code. Is there a different HCPCS we should be using? I tried using rev code 905, I tried using HCPCS S9480, and none of them will go through. The H0015 is also being rejected by another insurance company that is telling me that H0015 is considered a "temporary code" and I need to use the "permanent code". I have never even heard of a temporary code. I am new to coding and this is my first job, but I am only the biller, and our facility doesn't really have a coder. My boss is frustrated because we have not been able to figure this out and no one has been able to help us. I am hoping someone here can help us to figure this out!!


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## DCripe (Sep 22, 2011)

So far we have just found that substance abuse is not covered.  Good luck! If you do find a way that you can get payment for this please post so we can also start getting paid for our substance abuse services.


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## huggarat2 (Sep 28, 2011)

I am under the same belief that Medicare does not pay for AODA services other than the SBIRT - see: https://www.cms.gov/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf - on an OP basis.  Also, according to the 2011 HCPCS Level II code book, the H codes are for Medicaid agencies, not Medicare, so they would not work if billing Medicare.  If you are billing Medicare for Substance Abuse, check the article referenced above and if your services fall under the guidelines, you could try the G0396 or G0397 to Medicare.

My question:  we just received a request from Anthem for a HCPCs code on an AODA IP stay (room and board) which I have been unable to find and was not aware of the need prior to this claim.  I am researching the use of H0047 (AODA  services, NOS) for my insurance claim.  If anyone has other suggestions, please fire away!


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## abalkevitch (Sep 28, 2011)

01129060 said:


> So far we have just found that substance abuse is not covered.  Good luck! If you do find a way that you can get payment for this please post so we can also start getting paid for our substance abuse services.



I am new to this, so my question is if you are not getting paid for these services are you writing them off? Or billing the patient? Like I said, Im unsure how to proceed also. But the article posted in the other response is really good, and I printed it and gave it to my supervisor to look into.


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## codquist (Oct 13, 2011)

*Any update?*

I too just started with a substance rehabilitation facility and I am seeing the same issue. 
I'm on the search for clarity with Medicare - have any of you received any updates on this issue?

thanks   






abalkevitch said:


> I work at an IP/OP psych facility, and we do Intensive Outpatient Substance Abuse programs. We have been billing this for Medicare on a UB with rev code 906 and HCPCS
> H0015, but they are all being rejected for incorrect HCPCS code. Is there a different HCPCS we should be using? I tried using rev code 905, I tried using HCPCS S9480, and none of them will go through. The H0015 is also being rejected by another insurance company that is telling me that H0015 is considered a "temporary code" and I need to use the "permanent code". I have never even heard of a temporary code. I am new to coding and this is my first job, but I am only the biller, and our facility doesn't really have a coder. My boss is frustrated because we have not been able to figure this out and no one has been able to help us. I am hoping someone here can help us to figure this out!!


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## codquist (Oct 13, 2011)

*working together*

I'm willing to work together on this by the way!  Keep in touch




abalkevitch said:


> I work at an IP/OP psych facility, and we do Intensive Outpatient Substance Abuse programs. We have been billing this for Medicare on a UB with rev code 906 and HCPCS
> H0015, but they are all being rejected for incorrect HCPCS code. Is there a different HCPCS we should be using? I tried using rev code 905, I tried using HCPCS S9480, and none of them will go through. The H0015 is also being rejected by another insurance company that is telling me that H0015 is considered a "temporary code" and I need to use the "permanent code". I have never even heard of a temporary code. I am new to coding and this is my first job, but I am only the biller, and our facility doesn't really have a coder. My boss is frustrated because we have not been able to figure this out and no one has been able to help us. I am hoping someone here can help us to figure this out!!


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## codquist (Mar 7, 2012)

*Answer*

It's not a covered benefit. Intervention is recognized and the documentation requirements are on the Medicare webste. Provide a documentation template for your facility and contact your Medicare Provider rep who contracted with the facility and discuss two G codes.


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## American_Ginger (Mar 19, 2012)

At our clinic we call the pt ins. before we see them to find out if they have mental heath benefits. When we do this we also find out if the pt has substance abuse benefits. Doing this cuts down on the suprise that ins won't pay. I don't think that Medicare covers substance abuse but Medicaid does. If you want to give care to these pts, they would have to be self pay.


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## kbstickler (Aug 12, 2013)

*H0015-question please*

I'm also new to psych billing/coding.  A question I do have is if HCPCS H0015 includes the drug screening tests while undergoing the IOP services?  Can we or a lab bill the patients insurance separately for the screening while in therapy??

Thanks, Kristie


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## kblank08 (Feb 25, 2014)

*IOP and Medicare*

Medicare does not cover IOP....Make sure you have the patient sign an ABN prior to them being seen. They will be self pay.


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## jcochran (Mar 4, 2014)

abalkevitch said:


> I work at an IP/OP psych facility, and we do Intensive Outpatient Substance Abuse programs. We have been billing this for Medicare on a UB with rev code 906 and HCPCS
> H0015, but they are all being rejected for incorrect HCPCS code. Is there a different HCPCS we should be using? I tried using rev code 905, I tried using HCPCS S9480, and none of them will go through. The H0015 is also being rejected by another insurance company that is telling me that H0015 is considered a "temporary code" and I need to use the "permanent code". I have never even heard of a temporary code. I am new to coding and this is my first job, but I am only the biller, and our facility doesn't really have a coder. My boss is frustrated because we have not been able to figure this out and no one has been able to help us. I am hoping someone here can help us to figure this out!!



I know in some instances where Medicare doesn't cover a service, that service can be billed to the secondary insurance using a GY modifier, then it may be covered? Would this work for you? We don't do inpatient here, but we have used GY for our OP clients (we bill on HCFA's). Might ask? If the client has a secondary insurance that is....


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## Robyn07 (Mar 5, 2014)

*H0015*

I work in behavioral health for Medicaid and you are correct in saying that Medicare will not cover these codes/services.

They are covered by Medicaid (AHCCCS) in Arizona, and can be billed for denial and then sent to the 2ndary.

Hope this helps.

Robyn


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