Georgia’s Medicaid program, simply called “Georgia Medicaid,” covers the full continuum of care for substance use disorder patients. Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) contracts with addiction treatment providers throughout the state to deliver residential, IOP, outpatient and detox services to SUD patients. Billing Medicaid for services in Georgia is relatively straight-forward.
In today’s post, we’ll go over what treatment service categories are covered under Georgia Medicaid, as well as some of the most common CPT codes you’ll encounter when billing Medicaid for addiction treatment services in Georgia.
What addiction treatment services are covered under Georgia’s Medicaid program?
Georgia Medicaid covers inpatient, outpatient, and prescription drug treatment (MAT) for substance use disorder.
Specifically, covered services include:
Inpatient Hospital Services
Psychiatric Residential Treatment Facility (PRTF) Services
Detoxification Services
Partial Hospitalization
Methadone maintenance
Tobacco cessation counseling for pregnant women
Residential
Assessment/Evaluation
Crisis Services
Outpatient Services (e.g. Nursing, Medication Administration, etc.)
Counseling Services (e.g. Individual Therapy, Group Therapy, Family Therapy, etc.)
Intensive Outpatient Services (e.g. ACT, Substance Abuse Intensive Outpatient Program, Intensive
Family Intervention)
Rehabilitative Services (e.g. Psychosocial Rehabilitation, Peer Support, Skills Training, Task-Oriented Rehabilitation, etc.)
Case Management (e.g. Community Support, Case Management, Intensive Customized Care Coordination)
Detoxification Services
Psychological Services
Antidepressants
Antipsychotics
Anxiolytics
Mood Stabilizers
Opiate Dependence Treatments
Sedative Hypnotics
Stimulants
Naloxone Products
Acamprostate/Disulfiram
Vivitrol
Does Georgia Medicaid cover medication assisted treatment?
Yes, Georgia medicaid will cover MAT services, including methadone, under the fee-for-service program.
Georgia Medicaid also covers injectable naltrexone (Vivitrol), Suboxone, buprenorphine/naloxone tablets, and buprenorphine tablets under their fee-for-service plans. Suboxone, buprenorphine/naloxone tablets, and buprenorphine tablets may not exceed a dosage of 16 mg per day. Suboxone, buprenorphine/naloxone tablets, and buprenorphine tablets all require prior authorization under Georgia Medicaid.
Does Georgia Medicaid cover peer support services for addiction treatment?
Yes. Georgia actually was the first state to get Medicaid reimbursement approved for peer support services in 1999. Georgia manages a certification program for peer support specialists in the state and the presence of peer support specialists in the recovery landscape in Georgia has grown exponentially in the last 20 years.
Some of the most common CPT codes used for peer support services in Georgia include H2001, H2017, H2018, H0025, H0030, H0038, H2014, H2023, H2024, H2025, H2026, T1012, T1018, and T2012-T2021.
What are some of the most common addiction treatment CPT codes used for billing Medicaid in Georgia?
The following addiction treatment CPT codes are most commonly used for billing Medicaid in Georgia:
H2013 - Inpatient hospital services
H0008 - Inpatient detoxification services
H0009 - Inpatient detoxification services
G0129, G0176-G0177, G0410, G0411, H0035,or S0201 - Partial hospitalization
H0020, G6053 - Methadone maintenance
99406, 99407, 4000F, 4001F, G0436, G0437, G9016, S9453 - Tobacco cessation for pregnant women
H0017-H0019, H2021, H0043, T2048 - Residential treatment
H0031, 99446 - Addiction treatment assessment and evaluation
H0045 - Addiction treatment crisis care
H2010, 9672, T1000-T1005, T1021-T1022, T100-T1031, T1502-T1505 - Outpatient services
H0004, T1006-T1007, 90832-90834, 90836-90837, 90846-90847, 90853 - Counseling services (individual, group, family, etc)
H0015, H2022, H0036, T1025-T1027 - Intensive outpatient services
H2001, H2017-H2018, H0025, H0030, H0038, H2014, H2023-H2026, T1012, T1018, T2012-T2021 - Rehabilitative services (eg, education, peer support services, skills training, etc)
H2015-H2016, H0026, H0032, H0037, H0039-H0040, H0006, T1016-T1017, T2022-T2023, T1025-T1026, T2038, H0044 - Case management services
H0010-H0014 - Outpatient detox services
T1040-T1041 - Community mental health center
99201-99205, 99211-99215 - Psychological services
Does Medicaid in Georgia cover room and board at sober living homes or recovery residences?
No, Georgia Medicaid does not reimburse for sober living home room and board expenses.
Few, if any, states cover room and board at recovery residences. Sober living homes may accept other forms of public assistance, such as housing subsidies, but Medicaid does not allow sober living home room and board to be billed under the umbrella of addiction treatment.
Where can I find more information on Medicaid billing for addiction treatment in Georgia?
The following are some of the best resources for learning more about how to bill Medicaid for addiction treatment services in Georgia:
Georgia Medicaid Community Provider Manuals
The Georgia Medicaid Management Information System (GAMMIS)
Certified Peer Specialists in Georgia
Other Behave Health blog posts about the addiction treatment community in Georgia
How to Open a Licensed Addiction Treatment Center in Georgia
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