Medicaid Billing for Massachusetts Addiction Treatment Programs
What organizations administer Medicaid and addiction treatment services in Massachusetts?
Medicaid in Massachusetts is overseen by MassHealth.
Massachusetts’ Bureau of Substance Addiction is responsible for maintaining the standards and guidelines addiction treatment providers must follow in Massachusetts.
What addiction treatment services are covered for Medicaid patients in Massachusetts?
Massachusetts’ Medicaid program, MassHealth, covers a wide range of addiction treatment services, including:
Inpatient services
24-hour community-based services
Stabilization services
Opioid treatment services
Clinical laboratory services
Outpatient services
Community support services
Inpatient detoxification for pregnant members
Structured outpatient addiction program (or SOAP)
Enhanced structured outpatient addiction program (or E-SOAP)
Telehealth services
MAT services
Buprenorphine
Methadone
What are some of the most commonly used CPT billing codes used for Medicaid billing at addiction treatment programs in Massachusetts?
You can find the entire range of CPT codes accepted for addiction treatment billing at MassHealth in Subchapter 6 of the MassHealth Substance Use Disorder Treatment Manual, under the header, “Substance Use Disorder Treatment Service Codes.” MassHealth accepts a wide number of CPT codes and modifiers, including modifiers that are specific to programs that deliver addiction treatment services to special populations, such as young people and pregnant or postpartum patients. To learn more about how CPT codes are used for addiction treatment billing, refer to our post on the Top 3 CPT Codes for Addiction Treatment.
The most commonly used CPT codes for addiction treatment Medicaid patients in Massachusetts are:
H0010 sub-acute detoxification, inpatient addiction treatment
H0011 acute detoxification, inpatient addiction treatment
H2036HK alcohol and/or other drug treatment program, per diem
H2036HF alcohol and/or other drug treatment program, per diem
H0018 Short-term residential treatment without room and board, per diem
H0019 Halfway house services, without room and board
H0019TH Long-term residential, without room and board, per diem
H0019HR Long-term residential, without room and board, per diem
H0019HH Halfway house, per diem
H0019HF Long-term residential, without room and board, per diem, transitional age youth
H0019HD Long-term residential, without room and board, postpartum enhancement
H2016HM Comprehensive community support, recovery coaching
G2067 MAT, methadone, weekly bundle
G2068 MAT, buprenorphine, oral, weekly bundle
G2073 MAT, naltrexone, weekly bundle
G2074 MAT, weekly bundle for SUD counseling, individual and group therapy, and drug testing
G2076 MAT, intake
G2078 Take-home supply of methadone, up to 7 days
G2079 Take-home supply of buprenorphine, up to 7 days
H2015HF Community support services, recovery support, per 15 minutes
80305, 80306, 80307 Drug testing
97810HF Acupuncture, one or more needles
H0004 Behavioral health counseling, per 15 minutes
H0005 Alcohol and/or drug services, group counseling, per 45 minutes
T1006 Alcohol and/or substance use services, family and couple counseling, per 30 minutes
H2015HF Comprehensive community support services, per 15 minutes, Recovery Support Navigator
99202 Office or outpatient evaluation and management of new patient, 15-29 minutes
99203 Office or outpatient evaluation and management of new patient, 30-44 minutes
99204 Office or outpatient evaluation and management of new patient, 454-49 minutes
99205 Office or outpatient evaluation and management of new patient, 60-74 minutes
99211 Office or outpatient visit of established patient, less than 10 minutes
99212 Office or outpatient visit of established patient, 10-19 minutes
99213 Office or outpatient visit of established patient, 20-29 minutes
99214 Office or outpatient visit of established patient, 30-39 minutes
99215 Office or outpatient visit of established patient, 40-54 minutes
H0015 Intensive outpatient treatment, at least 3 hours per day, at least 3 days per week
98966 Telephone assessment and management by non-physician professional with established patient, 5-10 minutes
98967 Telephone assessment and management by non-physician professional with established patient, 11-20 minutes
98968 Telephone assessment and management by non-physician professional with established patient, 21-30 minutes
99441 Telephone evaluation and management by a physician, 5-10 minutes
99442 Telephone evaluation and management by a physician, 11-20 minutes
99443 Telephone evaluation and management by a physician, 21-30 minutes
Does MassHealth cover peer support services for addiction treatment?
Yes. In addition to free Peer Support Recovery Centers, the state of Massachusetts offers Recovery Coaching and Recovery Support Navigation through MassHealth. Refer to the list of common CPT codes in this blog post to locate the relevant CPT codes for these services.
Read More About Behavioral Health, Addiction Treatment, and Sober Living Management in Massachusetts
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Behave Health Knows Massachusetts Medicaid Billing for Addiction Treatment
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