In Part 3 of our 7-part series, we detail CVS Health’s Aetna guidelines for addiction treatment services. This post breaks down key elements—from detox and inpatient rehab to PHP/IOP and MAT—highlighting the use of ASAM Criteria, precertification protocols, and essential billing codes to ensure medical necessity and optimal reimbursement.
Comprehensive Eating Disorder Treatment Planning for Behavioral Health Professionals
Mastering IOP Billing: CPT Codes, Insurance Reimbursement, and Licensing
What is IOP Billing and How Does It Work? IOP (Intensive Outpatient Program) billing involves using HCPCS codes like H0015 (substance use IOP) and S9480 (mental health IOP) to submit claims for bundled daily services. Most insurers require pre-authorization, condition code 92 (for Medicare), and a minimum of 9 hours of weekly treatment to qualify for reimbursement. Proper coding, medical necessity documentation, and adherence to payer guidelines help ensure claim approval and avoid denials.
Everything You Need to Know About Insurance Billing for Addiction Treatment in Pennsylvania
Benefits of TMS in Addiction Treatment and Recovery
The Biggest Insurance Billing Mistakes Addiction Treatment Providers Make in Ohio
Answers to Your Top Questions About Addiction Treatment Billing in Illinois
Denial Rates for Addiction Treatment with Centene Corporation (With Level of Care Breakdown!)
Here's How to Find the Addiction Treatment Billing Claims Address for Blue Cross Blue Shield of Minnesota
Top 5 Addiction Treatment Diagnosis Codes to Use for URs with Healthfirst Insurance
How to Complete Insurance Registration with Florida Blue for Addiction Treatment Centers
Finding Addiction Treatment Billing Contact Information for Blue Cross Blue Shield Association Corporation
How to Find the Right Billing Claims Address for Addiction Treatment Patients with Cigna Health Insurance
Everything You Ever Wanted to Know About Aetna Precertification for Addiction Treatment Billing
What Anthem Inc's Level of Care Denial Rates Mean for Your Addiction Treatment Center's Billing Department
How to Quickly Appeal a Centene Corporation Health Addiction Treatment Claim Denial Using the Expedited Appeal Line
How to Determine the Medical Necessity of Addiction Treatment Services for UnitedHealth Group, Inc
Here’s How to Fix Your Substance Abuse Billing Issues
Dive Into the Top 3 CPT Codes for Addiction Treatment: H0001HF, H0004HF, and 96164HF
Has Your Addiction Treatment Center Nailed Outcomes Tracking Yet? Here's Why It's More Critical Than Ever
Large-scale research for addiction treatment lags far behind research for other health conditions. As an industry, we’ve been slow to move towards standardized models for understanding and evaluating the success of our work. That’s changing now as market forces are requiring the addiction treatment to undertake objective progress monitoring and outcomes tracking as never before.