Substance Abuse Billing Cheat Sheet (2026)
Substance use disorder billing mixes structured screening, medication-assisted treatment bundles, and state Medicaid H-codes, all under stricter confidentiality than the rest of medicine. The denials come from the screening time tiers, the MAT bundle rules, and parity-driven frequency limits.
Quick reference for substance abuse billers. Last updated .
Top Substance Abuse CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 99408 | Alcohol or substance abuse structured screening, 15-30 minutes | $35.07 | $27.72 | 1.05 |
| 99409 | Alcohol or substance abuse structured screening, more than 30 minutes | $67.47 | $55.45 | 2.02 |
| 90791 | Psychiatric diagnostic evaluation | $173.35 | $137.28 | 5.19 |
| 90832 | Psychotherapy, 30 minutes | $85.84 | $69.47 | 2.57 |
| 90834 | Psychotherapy, 45 minutes | $113.90 | $91.85 | 3.41 |
| 90837 | Psychotherapy, 60 minutes | $167.00 | $135.27 | 5.00 |
| 90853 | Group psychotherapy | $30.39 | $24.38 | 0.91 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Substance Abuse billing services page.
Modifiers That Prevent Substance Abuse Denials
Synchronous video (95) or audio-only (93) telehealth for counseling and MAT management where the payer allows it.
A substance use disorder program service designator many Medicaid and MCO plans require for correct routing.
An opioid use disorder treatment program designator where the payer distinguishes the OUD benefit.
A significant, separately identifiable E/M on the same day as screening or a MAT management service.
A distinct service, such as individual then group, that the payer would otherwise bundle.
Provider designators (psychiatrist, clinical psychologist) where the payer requires them for adjudication.
Top Substance Abuse Denials → Quick Fix
99408 is 15 to 30 minutes and 99409 is more than 30 minutes of structured screening and brief intervention. Document the time; the tier is time-defined.
When billing the monthly OUD treatment bundle (G2086 series), do not separately bill the components included in it. Bill the bundle or the components, not both.
Many state Medicaid programs require H-codes (such as H0001) with specific modifiers and units. Match the H-code, modifier, and unit definition to that state's manual.
Document medical necessity and invoke MHPAEA parity in the appeal when the SUD limit is stricter than the medical and surgical benefit.
Under 42 CFR Part 2, SUD records require specific consent. Ensure documentation release for appeals follows Part 2; an improper release is both a denial and a compliance problem.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 99408 | 0362T | Misuse of Column Two code with Column One code |
| 99408 | 0373T | Misuse of Column Two code with Column One code |
| 99409 | 0362T | Misuse of Column Two code with Column One code |
| 99409 | 0373T | Misuse of Column Two code with Column One code |
| 90791 | 0362T | CPT Manual or CMS manual coding instruction |
| 90791 | 0373T | CPT Manual or CMS manual coding instruction |
| 90832 | 0362T | CPT Manual or CMS manual coding instruction |
| 90832 | 0373T | CPT Manual or CMS manual coding instruction |
Documentation That Holds Up on Appeal
The structured screening tool used and the total time, since the code is time-tiered.
The bundle period and the services delivered, so components are not double-billed against the bundle.
The H-code, the required modifier, and the unit definition per the state manual.
Session time or the group structure, matching the psychotherapy time rules.
42 CFR Part 2 compliant consent for any release, including for appeals.
Revenue Substance Abuse Practices Leave on the Table
Defaulting SBIRT to the lower tier when documented time supports 99409.
Double-billing components against the monthly OUD bundle, which recoups on review.
State H-code claims denied for missing the state-required modifier or unit definition.
Accepting parity-driven frequency denials instead of appealing them under MHPAEA.
Substance Abuse Billing FAQ
How is SBIRT billed?
99408 for 15 to 30 minutes and 99409 for more than 30 minutes of structured screening and brief intervention. The screening tool used and the total time both have to be documented because the code is time-tiered.
Can I bill MAT components and the bundle?
No. When the monthly opioid use disorder bundle (G2086 series) is billed, the services included in it are not separately billable. Bill the bundle or the components, not both, or the overlap recoups.
Why do state Medicaid SUD claims deny?
Usually a mismatch between the H-code, the state-required modifier, and the unit definition. Each state Medicaid manual defines these specifically and the claim has to match it.
What does 42 CFR Part 2 change about billing?
SUD records have stricter consent requirements than general health records. Any release, including documentation for an appeal, must follow Part 2 consent, or it is both a denial risk and a compliance violation.
Stop Losing Substance Abuse Revenue to Preventable Denials
Our AAPC-certified substance abuse coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.