SUD-specific benefit riders, level-of-care coverage, and pre-certification requirements confirmed before intake begins.
Addiction Treatment & Rehab Medical Billing Services
Billing for Every Level of Rehab and Addiction Care, From Detox to Outpatient
Coding and claims support for detox, residential, partial hospitalization, intensive outpatient, and outpatient substance use disorder programs, built around how each level of care is actually authorized and paid.
HIPAA compliant
Certified billing and coding professionals
Nationwide service
🔒 100% confidential. We never sell your data. Privacy Policy
How Thrive Helps
Billing That Follows the Patient Through Their Rehab Journey
Thrive manages the billing side of your program so your clinical and admissions teams can stay focused on patient care. We handle verification of benefits before admission, track authorization and concurrent review dates for every level of care you operate, code claims using the correct HCPCS, CPT, and G-code combinations, and follow up on denials until they are resolved or successfully appealed. Whether your program includes detox, residential, PHP, IOP, or outpatient services under one roof, your billing runs through one accountable team instead of being split across spreadsheets, disconnected admissions logs, and rotating contacts.
HIPAA Compliant
Certified Professional Coders
Nationwide Coverage
95%+ clean claim rate across per diem and outpatient SUD claims
Average AR held under 30 days, even with multi-week residential stays
48-hour average claim turnaround from admission to submission
30% average revenue increase after onboarding
Full-Cycle RCM
RCM Support for Rehab, Addiction, and Substance Abuse Care
Every task below is coded and tracked against the level of care it belongs to, not treated as one generic billing workflow.
Verification of Benefits & Authorization Mapping
Concurrent Review & Renewal Tracking
Authorization windows tracked across detox, residential, PHP, and IOP stays so treatment days do not go unbilled.
Multi-Code-Set Claims Submission
HCPCS H-codes, CPT psychotherapy codes, SBIRT codes, and OTP G-codes submitted with the modifiers each payer requires.
Denial Management & Medical Necessity Appeals
Level-of-care and length-of-stay denials addressed with ASAM-aligned clinical documentation.
AR Follow-Up on Per Diem & Bundled Claims
Aging per diem claims and split-level stays followed until resolved, not left to age out.
Patient Billing & Assignment of Benefits Support
Clear patient statements and AOB documentation to help keep out-of-network payments routed to your program.
Payment Posting & Reconciliation
Per diem and session-based payments posted and matched against authorized treatment days.
Credentialing & Payer Enrollment
Facility and provider enrollment support across commercial, Medicaid, and behavioral health carve-out networks.
Level-of-Care Reporting
Census and revenue reporting broken out by level of care and payer, not one blended number.
Coding Reference
HCPCS, CPT & ASAM Code Reference for Rehab Billing
The codes treatment programs bill most often, mapped to the level of care each one covers.
- H0001
Assessment
Alcohol and drug assessment performed at intake, often required before a level of care can be authorized.
- 90791
Diagnostic Evaluation
Psychiatric diagnostic evaluation used at intake when a formal diagnosis is documented alongside the SUD assessment.
- H0004
Outpatient (ASAM 1.0)
Individual counseling billed per 15-minute unit for standard outpatient care.
- H0005
Outpatient (ASAM 1.0)
Group counseling billed for standard outpatient group sessions.
- H0015
Intensive Outpatient (ASAM 2.1)
Structured programming, roughly 9 to 19 hours per week, billed per day in most states.
- S9480
Intensive Outpatient (Commercial)
Commercial-payer counterpart to H0015, used by payers that do not recognize the Medicaid H-code.
- H0010-H0014
Detoxification (ASAM 3.7 / 4.0)
Detox services across ambulatory, residential, and hospital settings, coded by acuity level. Commonly the starting point for cpt code for inpatient rehabilitation searches.
- H0017
Residential, Hospital-Based
Hospital-based residential treatment, billed without room and board.
- H0018
Residential, Short-Term (ASAM 3.1 / 3.5)
Non-hospital residential treatment typically under 30 days, billed per diem.
- H0019
Residential, Long-Term (ASAM 3.5)
Non-hospital residential treatment typically over 30 days, billed per diem.
- H2036
Partial Hospitalization (ASAM 2.5)
Full-day structured programming, used by some payers in place of H0015 at the PHP level.
- H0020
Opioid Treatment (Methadone)
Methadone administration and related dosing services at an opioid treatment program.
- H0038
Peer Support
Peer recovery support services billed per 15-minute unit, in states that cover them.
- 99408 / 99409
SBIRT Screening
Alcohol and substance use screening and brief intervention, billed by time (15-30 min / 30+ min).
- G2067-G2072
Opioid Treatment (Medicare OTP)
Medicare OTP bundled codes covering intake, methadone, buprenorphine, and naltrexone dosing.
Where Revenue Gets Stuck
Common Billing Challenges for Rehab
Level-of-Care Documentation Gaps
When intake and progress notes do not clearly address all six ASAM dimensions, especially recovery environment and relapse risk, reviewers deny or shorten stays even when the clinical picture supports them.
Concurrent Authorization Lapses
Residential and PHP stays require renewed authorization at set intervals. A single missed renewal call can leave several treatment days unbilled or denied outright.
Per Diem and Same-Day Therapy Bundling
Billing a per diem code and a separate individual therapy code for the same treatment day is a pattern payers commonly flag during audit and recoupment review.
Missing Program and Credential Modifiers
Many Medicaid plans require a credential modifier and a program modifier like HF on the same claim, and the required pairing and order changes by state and plan.
Out-of-Network Payment Redirection
When a program is out-of-network, some payers send reimbursement directly to the patient. Without a signed assignment of benefits on file before admission, that revenue is hard to recover.
42 CFR Part 2 Consent Errors
SUD records carry stricter federal confidentiality rules than standard HIPAA. A consent form that does not meet current disclosure requirements can block a claim or a records request outright.
Step-Down Authorization Mismatches
When a patient moves from detox to residential to PHP to IOP, the authorization on file has to move with them. Claims billed above the current authorization are a frequent denial trigger.
SBIRT and Psychotherapy Same-Day Conflicts
Screening and brief intervention codes billed alongside psychotherapy on the same date require a distinct-service modifier. Without it, one of the two claims is typically denied as duplicate.
Our Process
How We Address These Challenges
Verification of Benefits & Authorization Mapping
Before a patient is admitted, we confirm SUD-specific benefit coverage, level-of-care limits, and pre-certification requirements, and secure a signed assignment of benefits to protect out-of-network payments.
ASAM-Aligned Coding & Documentation Review
Claims are coded to match the level of care actually documented across all six ASAM dimensions, closing the gap between what is billed and what the chart supports.
Clean Claim Submission With Correct Modifiers
Program-type, credential, and telehealth modifiers are applied per payer requirement before a claim ever reaches the clearinghouse.
Concurrent Review & Renewal Tracking
Authorization windows for every open case are tracked so continued-stay requests go out before a treatment day becomes unbillable.
Denial Root-Cause Review & Appeals
Level-of-care and length-of-stay denials are appealed with documentation organized around the specific ASAM dimension a reviewer challenged.
AR Follow-Up & Reporting
Per diem and session-based claims are followed through to payment, with reporting broken out by level of care and payer.
Why Thrive
Why Treatment Programs Choose Thrive
SUD-Specific Coding Expertise
Our coders work across HCPCS H-codes, ASAM-aligned per diem levels, SBIRT, and OTP G-codes daily, not as an occasional add-on to general behavioral health billing.
42 CFR Part 2 Aware Compliance
Claims and records handling follow the stricter federal confidentiality standard that applies to SUD treatment records, layered on top of standard HIPAA compliance.
Nationwide Payer Experience
We work across commercial, Medicaid, and behavioral health carve-out payers in all 50 states, not one regional market.
Authorization & Concurrent Review Discipline
Every open case is tracked against its authorization window so treatment days do not quietly become unbillable.
Transparent Level-of-Care Reporting
You see census, revenue, and denial data broken out by level of care, not a single blended number.
Audit-Ready Documentation Alignment
Coding is checked against what the chart supports before submission, reducing recoupment risk during payer audits.
Get Started
Talk to a Rehab and Addiction Billing Specialist
Get a free 15-minute practice revenue review. We’ll look at your current claim performance, open authorizations, and level-of-care mix, and show you exactly where revenue is at risk.
Book Your Free Revenue Analysis
Schedule a 15-minute meeting to review where anesthesia claims, denials, payments, and AR follow-up are slowing collections.
🔒 100% confidential. We never sell your data. Privacy Policy
FAQ
Frequently Asked Questions
How much does rehab and addiction treatment billing cost?
Fees are set as a custom fee schedule based on your program's census, level-of-care mix, and current claim performance, not a flat percentage that treats detox the same as outpatient care. Request a free revenue review and we'll walk through pricing specific to your program.
How long does onboarding take?
Most programs are fully onboarded in under a week. We review your current billing workflow, map open authorizations, and align coding before your first claims move through us, with minimal disruption to admissions or clinical operations.
Can you take over our existing AR and open per diem claims?
Yes. We review aging claims, confirm which authorizations are still active, and prioritize recoverable balances first, so you are not starting your revenue cycle over from zero when you switch billing partners.
Do you bill detox, residential, PHP, IOP, and outpatient levels of care under one contract?
Yes. Most programs we support operate more than one level of care, and each is coded and billed under its own rules, whether that is a per diem residential claim or a session-based outpatient claim, all through one accountable team.
How do you handle denials tied to ASAM level-of-care disputes?
We review the denial reason against the documented ASAM dimensions, work with your clinical team to strengthen the record where needed, and file an appeal organized around the specific dimension the reviewer challenged, rather than a generic resubmission.
Are you familiar with 42 CFR Part 2 and how it affects billing?
Yes. SUD treatment records carry stricter federal confidentiality requirements than standard HIPAA, and our billing and consent handling processes are built around those requirements, including the 2024 update aligning Part 2 consent forms more closely with HIPAA.
How do we track our numbers once you take over billing?
You get ongoing reporting broken out by level of care, payer, and program, along with a dedicated point of contact, so you can see clean claim rate, AR aging, and authorization status without waiting on a monthly summary.
Do you work with treatment centers in every state?
Yes. We support rehab and addiction treatment programs nationwide and are familiar with how Medicaid H-code requirements, revenue code pairings, and behavioral health carve-out payers differ from state to state.
FREE REVENUE ANALYSIS
Ready to Stop Losing Revenue on Level-of-Care Denials?
Get a no-cost, no-obligation review of your program’s billing performance and a clear picture of what’s recoverable.
- HIPAA Compliant
- Certified Billing & Coding Support
- Surgical & Procedure Claims
- Nationwide Support