We’ve covered CPT and HCPCS codes for addiction treatment extensively on this blog, including a very well-loved post about some of the most popular CPT codes in addiction treatment billing, namely H0017, H0018 and H0019. This post, entitled, Understanding HCPCS and CPT Billing Codes for Residential Addiction Treatment: H0017, H0018, H0019 contains a lot of great information for billing departments looking for the nitty-gritty details on these H-Codes. While our original post on these codes is still full of good information, 2024 saw some small changes to the CPT codeset that do have the potential to affect addiction treatment billing.
Today, we’ll update the information contained in that post for 2024.
Updates to CPT and HCPCS Codes for 2024 Behavioral Health and Addiction Treatment Billing
The Centers for Medicare and Medicaid Services, also known as CMS, released their annual update to CPT/HCPCS codes on September 8th, 2023.
You can read their update notification here.
The new “codeset” comprises 11,163 codes that cover a dizzying array of medical services. The update contains a whopping 349 “editorial changes.” The 2024 update also contains 230 new additions. An additional 49 changes involved removing formerly accepted codes. Finally, 70 different “revisions” were made to the codeset, too.
The good news? Very few changes were actually made to the CPT codes most commonly used for behavioral health care. That includes H0017, H0018, and H0019.
CPT Code Changes for 2024 Allow Providers to be Reimbursed at the Non-Facility Rate for Telehealth services
The changes that CMS made to rules for telehealth are perhaps the most important changes for addiction treatment billing in 2024. The yearly update established a new policy where providers are to be reimbursed at the “non-facility rate” for telehealth sessions provided in the patient’s home. In order to exercise this new reimbursement, billers need to alter the modifier 95 to telehealth claims to 02 (for telehealth provided somewhere other than the patient’s home) or 10 (for telehealth provided at a patient’s place of residence).
2024 Update for Billing Code H0017: Behavioral Health - Residential Without Room and Board
H0017 describes one day of clinical services at a residential behavioral health or addiction treatment center. It does not cover the room and board, but, rather, covers all of the clinical services that take place during treatment
H0017 is an H-code, which are always preceded by an “H” and followed by 4 numbers. These codes are always used for services that are unique to behavioral health care, so when you see an “H” code, you’ll always know that that service is definitely a behavioral health service.
Because H0017 is both a recognized CPT code as well as a recognized HCPCS code, it can be used to bill public insurance programs like Medicaid as well as private insurance.
2024 Update for Billing Code H0018: Behavioral Health - Short-Term Residential Without Room and Board
H0018 is the code used for short-term residential behavioral health services. This code can only be used for residential treatment - not hospital programs or outpatient programs. For the purposes of H0018, short-term residential means a program that runs for less than 30 days. The typical 28 day program falls under the “short-term residential” umbrella.
H0018, like H0017, can be used to bill both private and public insurance programs because it is both a CPT code and an HCPCS code. Also like H0017, H0018 may not be used to bill for room and board. It is only for clinical services in a short-term setting.
2024 Update for Billing Code H0019: Behavioral Health - Long-Term Residential Without Room and Board
H0019 is for long-term residential treatment programs. For the purposes of this H-code, long-term services run longer than 30 days. Many long-term programs that use H0019 run for 60, 90 or 120 days. These programs are often for patients with severe SUD symptoms, complex health histories, co-occurring disorders and/or dual diagnosis patients.
H0019 is only for residential programs. These programs cannot take place at a hospital setting or any other acute care facility, whether that’s a general health setting or a mental health setting.
More on Behavioral Health Billing
Is It Time to Outsource Your Addiction Treatment Medical Billing?
Medicaid Billing for Massachusetts Addiction Treatment Programs
Secrets of Medicaid Billing for Addiction Treatment in Washington
How to Optimize Addiction Treatment Billing for Virginia Medicaid
5 Keys to Medicaid Billing for Addiction Treatment in New Jersey
Want to Simplify Your Billing? Try Behave Health
Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers.
Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.
Get your free trial started today and see why more addiction treatment centers prefer Behave Health.
PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with Licensing or Accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!