Substance use disorder billing lives at the intersection of behavioral health parity, ASAM level-of-care criteria, and payer prior auth. Documentation built around ASAM wins authorization. Generic documentation loses it.
We see the same patterns across substance abuse (sud) groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for substance abuse (sud) practices.
| Code | Description | Profile |
|---|---|---|
| H0015 | Alcohol and drug services, intensive outpatient | High volume |
| H0035 | Partial hospitalization, mental health | Modifier-sensitive |
| H0001 | Alcohol and drug assessment | Denial-prone |
| 99408 | Alcohol and drug abuse screening, 15 to 30 min | High volume |
| J0570 | Buprenorphine implant | Modifier-sensitive |
| J2315 | Naltrexone injection (Vivitrol) | Denial-prone |
| G2086 | Office-based opioid use disorder treatment, monthly | High volume |
ASAM documentation built into each level of care. Prior auth workflow by payer (commercial, Medicaid, Medicare) with typical review cycles. Parity appeals prepared when authorization falls below ASAM-supported level. MAT billing tracked across Suboxone, Vivitrol, and methadone workflows.
Pattern we see. Level of care denied (authorization at lower level than ASAM supports), MAT denied for missing induction documentation, and IOP concurrent review denied without engagement documentation.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable substance abuse (sud) denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.