Medicaid Billing Secrets for Addiction Treatment in Tennessee
What is Medicaid Called in Tennessee and what Department is Responsible for Addiction Treatment in the State?
Medicaid in Tennessee is called TennCare. According to a recent study, well over 65% of all addiction treatment centers in Tennessee accept Medicaid. That number is growing about .1% every year, with a total of 297 facilities treating SUD in Tennessee.
In Tennessee, some mental health and substance abuse services are separated out from TennCare under the umbrella of the Behavioral Health Safety Net. BHSN serves over 32,000 people with community-based behavioral health support a year. There are 153 BHSN locations throughout Tennessee.
Tennessee’s Department of Mental Health and Substance Abuse Services (TDMHSAS) oversees all addiction treatment services in the state, from residential to intensive outpatient.
Tenncare operates within a network of Managed Care Organizations. The main MCOs in Tennessee that administer Medicaid benefits are Wellpoint, BlueCare and UnitedHealthcare.
What Addiction Treatment Services are Covered in Tennessee Under TennCare?
TennCare services include:
Inpatient treatment
Residential treatment
Outpatient treatment
TennCare also provides free addiction treatment services for uninsured individuals, under a program called BHSN. It is not affiliated with Medicaid. According to the BHSN Provider Manual, BHSN services include:
Assessment and evaluation
psychological testing evaluation services
individual therapy
group therapy
psychosocial rehabilitation
peer support
case management
transportation
psychiatric medication management
administration of long acting injectables
labs related to medication management
What are the Most Commonly Used Medicaid CPT Codes for Addiction Treatment in Tennessee for TennCare?
Some of the most commonly used CPT codes for addiction treatment delivered via Medicaid to patients in Tennessee include:
Naltrexone, initial visit codes, 99201 – 99205
Naltrexone, subsequent visit codes, 99211 – 99215
Suboxone/buprenorphine – Comprehensive Medication services, (Subsequent visit) - H2010
Suboxone/buprenorphine – Comprehensive Medication services, (Initial visit) - H2010U1
Naltrexone initial visit codes 99201 - 99205
Naltrexone subsequent visit codes 99211 - 99215
Psychiatric diagnostic evaluation (with no medical services) - 90791
Psychiatric diagnostic evaluation (with medical services) - 90792
Psychological testing evaluation service - 96130
Psychotherapy, 60 minutes - 90837
Psychotherapy, 45 minutes - 90834
Psychotherapy, 30 minutes - 90832
Family/couple psychotherapy - 90847
Group psychotherapy - 90853
Drug screen with brief intervention (SBI) services, 15 - 30 minutes - 99408
Drug screen with brief intervention (SBO) services, 30 minutes - 99409
Drug screen only - H0049
Alcohol and/or drug abuse services, all-inclusive case rate, H0047
Individual psychosocial rehabilitation - H2017
Group psychosocial rehabilitation session - H2017HQ
Individual peer support session, 15 minutes, maxim of 4 per person on a single day - H0038
Group peer support session, 15 minutes, maximum of 24 units per person within a single day - H0038HQ
Case management - T1016
Non-emergency transportation, per diem - T2002
Non-emergency transportation, encounter/trip - T2003
Non-emergency transport bus - A0110
Psychiatric medication management: Office or outpatient evaluation and management - 99211
Psychiatric medication management: requiring history and/or examination, 10-19 mins - 99212
Psychiatric Medication management: requiring history and/or examination, 20-29 mins - 99213
Psychiatric Medication management: requiring history and/or examination, 30-29 minutes - 99214
Psychiatric medication management: requiring history and/or examination, 40-54 minutes - 99215
Mediation training and support, 15 minutes - H0034
Long acting injectable, therapeutic - 96372
Family support sessions with a CFSS, 15 minutes, maximum 8 per person or family on a single day of service - H2014
How is Eligibility Determined for Addiction Treatment Medicaid Services in Tennessee?
Eligibility for TennCare is determined by being a resident of the state of Tennessee, being over 18, and living at or below 138% of the federal poverty level, In 2024, this means that a single individual must make less than $20,783 a year to qualify for Medicaid in Tennessee. A family of four would need to make less than $43,056 per year.
Does Tennessee TennCare Cover Peer Support Services for Medicaid Patients?
Yes. According to Tennessee’s Peer Recovery Support Specialist Handbook, Medicaid reimburses for peer support services in the state. In order to be covered under Tenncare, all peer support must be delivered by a Certified Peer Recovery Specialist who is employed by an organization that is licensed by the Tennessee Department of Mental Health and Substance Abuse Services and they must also been under the supervision of a behavioral health professional.
When billing Tennessee Medicaid for peer support services, the relevant CPT codes are: H0038, which represents 15 minutes of individual peer support, and H0038HQ, which represents 15 minutes of group peer support. There are restrictions placed on each code: H008 may only be billed four times per person, per day, while H008HQ can only be billed 24 times per person per day.
Does Tennessee Medicaid Cover Sober Living Homes?
No. Sober living homes are not covered under Medicaid programs in Tennessee. They are rarely covered under state Medicaid programs.
More Information About Behavioral Health Billing, Medicaid, and Business in Tennessee
Here’s What it Takes to Open an Addiction Treatment Center in Tennessee
5 Things Every Tennessee Sober Living Home Business Startup Should Know
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