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Addiction Medicine & SUD Billing Services
Substance abuse billing runs on bundled codes, per-diem program rates and drug tests, all under federal privacy rules that go further than HIPAA. A wrong bundle, a drug test without a documented reason, or a record released without valid Part 2 consent can each cost a program its payment. Qualigenix bills medication for opioid use disorder, counseling, drug testing and level-of-care programs for addiction medicine practices, opioid treatment programs and SUD treatment centers.
How Is Substance Abuse Billing Different?
Substance abuse billing is different because one patient's care can be billed as a weekly opioid treatment program bundle, a monthly office-based bundle, a per-diem program day or individual counseling units, and each payer accepts a different mix. Qualigenix codes SUD services by setting and payer, verifies behavioral health benefits and authorizations, and handles records under 42 CFR Part 2. Call 786-259-0231 to talk through your program.
01
MAT & OTP Bundle Coding
Medicare pays enrolled opioid treatment programs (OTPs) through weekly bundles, G2067 to G2080, that differ by medication, and an OTP can bill only one bundle per patient for each 7-day episode. Office-based clinicians can't use OTP codes; they bill the monthly bundles G2086 to G2088 or standard E/M and counseling codes.
02
Auth for IOP, PHP & Residential
Residential treatment, partial hospitalization and intensive outpatient programs need authorization before admission and again at each concurrent review. A missed review date leaves days unpaid even when the patient still meets criteria.
03
Level-of-Care & Per-Diem Billing
Programs bill by the day or by the unit depending on the payer, and IOP and PHP rates can bundle group and individual therapy. Billing a session separately when the per-diem rate already covers it creates an overpayment.
04
Telehealth & Audio-Only SUD Care
Telehealth SUD visits need the right place-of-service code (02 or 10) and any modifier the payer requires, and payer rules on audio-only counseling differ. A video visit billed with an office place of service, or the reverse, can be paid at the wrong rate.
05
Carve-Outs & Behavioral Benefits
Some health plans manage SUD benefits through a separate behavioral health company, so the card a patient shows isn't always the company that authorizes or pays. Visit and day limits on the behavioral health benefit have to be checked before admission.
06
Drug Testing Medical Necessity
025 review, and missing urine drug screen risk assessments were among the top root causes. A drug test needs an order, a documented reason and a result in the chart.
07
Concurrent Review Denials
Level-of-care programs are reviewed while care is ongoing, and a payer can stop authorizing days partway through a stay. Denied days need a peer-to-peer review or an appeal with progress notes showing the patient still meets criteria.
08
42 CFR Part 2 Consent Rules
Records from a Part 2 program carry federal protections beyond HIPAA. Under the 2024 final rule, programs had to comply by February 16, 2026, and HIPAA's civil and criminal penalties now apply to Part 2 violations.
How Qualigenix Closes Each SUD Billing Gap
Qualigenix answers each gap with a step its SUD billing team runs before and after the claim.
MAT & Bundle Code Accuracy
Coders match each service to the code family for its setting, whether OTP weekly bundles, office-based monthly bundles, or E/M and counseling codes, and check medication-specific bundles against the dosing record.
IOP, PHP & Residential Auths
We request the initial authorization and calendar every concurrent review date, sending updated clinical notes before the approved days run out.
Per-Diem & Unit Reconciliation
Each program day is reconciled against attendance and the payer's per-diem rules, so services already in the rate aren't billed twice.
Telehealth Modifier & POS Checks
Telehealth claims are checked for place-of-service code, modifier and the payer's audio-only policy before submission.
Carve-Out Benefit Verification
We identify whether a behavioral health company manages the benefit, confirm day and visit limits, and request the authorization from the right company.
Drug Test Order & Risk Notes
Drug tests are billed only when the order, the clinician's risk assessment and the result are in the chart, and presumptive and definitive tests are coded separately.
Concurrent Review Tracking & Appeals
Denied days are appealed with progress notes and level-of-care criteria. Qualigenix overturns 79% of the denials it works, with an average appeal turnaround under 9 days.
Part 2-Compliant Claims Handling
SUD records are released under the Part 2 consent the patient signed, and a claim or appeal carries only the information the payer needs to pay it.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
SUD Coding by Treatment Setting
SUD codes change with the setting, so the same counseling session can carry a different code in an OTP, an office or a residential program.
OTP Weekly Bundles (G2067–G2080)
G2067 to G2075 are weekly bundles by medication, or for a week without medication. G2076 to G2080 are add-ons for intake, periodic assessment, take-home doses and extra counseling, and freestanding OTPs billing on the institutional claim use type of bill 087x.
COMPLIANCE
How We Keep SUD Billing Compliant
Qualigenix keeps SUD billing compliant by releasing records only under the patient's Part 2 consent, billing bundles by the rules for each setting, and billing drug tests only with a documented order and risk assessment. The 2024 Part 2 final rule brought many of its requirements closer to HIPAA, and since February 16, 2026, the HHS Office for Civil Rights accepts Part 2 complaints and enforces HIPAA penalties for violations. Medicare allows an OTP one weekly bundle per patient per 7-day episode, and clinicians can't bill OTP codes for office-based care. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%, and all work is HIPAA compliant, with patient data handled under strict security controls.
0%
Audit Pass Rate
<0%
Variance Threshold
Why Qualigenix
0%
IMPROPER PAYMENT RATE
0%
FROM DOC GAPS
0%
FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
We request the initial authorization before admission, calendar every concurrent review date, and send updated clinical notes before the approved days run out. Denied days are appealed with progress notes and level-of-care criteria.
Yes. We code telehealth SUD visits with the place-of-service code and modifier each payer requires, and check whether the payer covers audio-only counseling before billing it.
Yes. Qualigenix works in the EHR and billing system you already use and has worked across 133 EMR and EHR platforms.
Qualigenix onboards new practices in 6 days on average. Call 786-259-0231 to plan your start date.
Medicare-enrolled OTPs bill weekly bundles G2067 to G2080, while office-based clinicians bill monthly bundles G2086 to G2088 or E/M and counseling codes. Medicaid and commercial plans may use HCPCS H codes, J codes for injectable medication, or both.
We release SUD records only under the consent the patient signed and send payers only the information they need to process the claim. All work is HIPAA compliant and follows the 2024 Part 2 final rule.
Yes. We work open SUD claims by age, payer and denial reason, including denied program days. Qualigenix's A/R work has cut days in A/R from 54 to 36.