Billing for telehealth for substance use disorder treatment
Learn more about policies and reimbursement for telehealth services.
On this page:
Medicare
Substance use disorder (SUD) treatment is a type of tele-behavioral health and many of the billing codes and payment policies for the treatment of SUD are similar to those for virtual behavioral health care. Section 2001 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act removed geographic and originating site restrictions for the treatment of SUD or co-occurring mental health disorders using telehealth for Medicare patients. These flexibilities apply for individuals already diagnosed with a SUD. Diagnosis of a SUD or co-occurring mental health disorder via telehealth may be billed using an evaluation and management (E/M) code.
Medicare policies for telehealth continue to evolve. For the latest information, view the list of telehealth services. The following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are frequently used to bill for telehealth services. Coding guidance is subject to change.
| CPT/HCPCs code | Description | Time | Audio-only coverage | Permanent coverage |
|---|---|---|---|---|
| G0396 | Alcohol and substance misuse assessment | 15-30 min | Yes | Yes |
| G0397 | Alcohol and substance misuse assessment | 30 or more min | Yes | Yes |
| G0442 | Alcohol and substance misuse screening | 5-15 min | Yes | Yes |
| G0443 | Alcohol and substance misuse counseling | 5-15 min | Yes | Yes |
| G2086 | Treatment for opioid use disorder, first month | 70 or more min | Yes | Yes |
| G2087 | Treatment for opioid use disorder, subsequent months | 60 or more min | Yes | Yes |
| G2088 | Treatment for opioid use disorder | Additional 30 min | Yes | Yes |
Did you know?
Opioid Treatment Programs (OTPs) are federally certified entities authorized to treat opioid use disorder with FDA-approved medication, including methadone and buprenorphine. OTPs can receive reimbursement for therapy and counseling services delivered using audio-only technology.
Medicaid
Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit Medicaid and Medicare overview.
Private insurance
Find out if the patient has private insurance. If so, check with the patient's insurance company for information on their billing and reimbursement policies. For tips on private insurance policies, look up policy by jurisdiction.
More information:
Billing for Providers – What Should I Know? (PDF) — Health Resources and Services Administration
Billing for telehealth — Health Resources and Services Administration
Medicare and Medicaid policies — Health Resources and Services Administration
Medicare payment policies — Health Resources and Services Administration
Telehealth policy — Health Resources and Services Administration
Opioid Treatment Program Billing & Payment — Centers for Medicare & Medicaid Services
Medications for the Treatment of Opioid Use Disorder - Final Rule — U.S. Department of Health and Human Services
Understanding telehealth policy — National Telehealth Policy Resource Center