Treating patients with substance use disorders is taxing, especially when the relapse rate is between 40% and 60%. But what can really sink your ship is the never-ending rehab billing workload. You must file accurately coded, completely documented, and regulatory-compliant medical claims to collect reimbursements for the rendered care services. Hence, a thorough understanding of the common substance abuse and rehab CPT codes is a must.
In this detailed blog, we will unveil the frequently reported substance abuse CPT codes at rehabilitation centers for inpatient and outpatient services so you can ace the billing game for the remaining year.
- Substance Abuse CPT Codes for Alcohol Screenings
- Substance Abuse CPT Codes for Crisis Intervention
- Substance Abuse CPT Codes for Psychotherapies
- Rehab CPT Codes for Evaluation and Management
- Rehab CPT Codes for Medication Management
- Substance Abuse CPT Codes for Clinical Assessments
- Rehab CPT Codes for Group Therapies
- Bottom Line
Substance Abuse CPT Codes for Alcohol Screenings
Around 20% of adults in the United States are addicted to alcohol, and only 7% of them seek treatment for it. It is the most abused substance in the country, and nearly 95,000 deaths are reported each year because of alcohol abuse.
Substance abuse counselors and addiction specialists may order an alcohol screening if they suspect that the patient is an over-drinker and at risk of an alcohol use disorder (AUD). The screenings are used for preventative care and can help the provider identify if the patient’s alcohol consumption is within the safe limits. The following substance abuse CPT codes are reported for time-based alcohol screenings.
CPT Code 99408 – Alcohol Screening (15 to 30 Minutes)
The healthcare provider uses this substance abuse CPT code to collect reimbursement for a 15-30-minute screening session in which the patient is tested for alcohol and other non-tobacco substances. The provider also performs a brief intervention during the session, e.g., designing a treatment plan or offering counseling.
The screening test may be a questionnaire (multiple choice questions), a blood test, or a breathalyzer.
CPT Code 99409 – Alcohol Screening (30+ Minutes)
Alcohol screening with the CPT code 99409 is similar to the one above, except the test lasts longer than 30 minutes. After the detailed screening, the provider performs a brief intervention to prevent AUD.
Substance Abuse CPT Codes for Crisis Intervention
Several correlation studies have shown that people with drug and alcohol addiction are at higher risk of committing suicide. In fact, suicide is a leading cause of death among US adults. More than 49,000 adult Americans die of suicide each year simply because they are unable to receive help at the right time.
The following substance abuse CPT codes are used when healthcare providers intervene and perform psychotherapies in critical situations. You must remember that addicts are prone to erratic behavior/violence and may harm others or themselves. Hence, intervention by a specialist is crucial.
CPT Code 90839 – Crisis Intervention (First 60 Minutes)
This substance abuse CPT code is reported when the provider meets a patient in a life-threatening condition and performs psychotherapy for 30 to 74 minutes. The intervention aims to diffuse the crisis and help the patient overcome suicidal tendencies.
It is a short-term management technique and may be followed by drug administration (psychedelics) to calm the patient and stop them from being violent toward themselves or others.
CPT Code 90840 – Crisis Intervention (Additional 30 Minutes)
90840 is an add-on substance abuse CPT code and is used when the provider is unable to manage the crisis within the first 60 minutes. If the provider needs more time to calm the patient and de-escalate the life-threatening condition, CPT code 90840 is used. It reports every 30 minutes of additional psychotherapy or crisis intervention.
Substance Abuse CPT Codes for Psychotherapies
According to the National Institute on Drug Abuse (NIDA) and the Columbia University Department of Psychiatry, people with substance abuse disorders also have an underlying mental health condition.
NIDA’s findings state that 60% of the patients who are enrolled in community-based substance abuse treatment programs meet the DCM-5 diagnostic criteria for mental health conditions. Similarly, the researchers at Columbia University found that out of the 46.3 million people with substance abuse disorder in 2021, 19.4 million also had a mental illness like acute anxiety or bipolar disorder.
This correlation seems rational when we realize that people with serious psychological disorders often resort to substances to cope with their illness and the side effects of their medications, leading to addiction. Therefore, psychotherapies don’t just target alcohol/drug addiction but also the underlying mental health condition.
The following substance abuse CPT codes cover individual, family, and group psychotherapies.
CPT Code Range 90832-90838 – Individual Psychotherapies
There are six substance abuse CPT code sets for individual psychotherapies. The provider conducts timed sessions with the patient and uses several techniques like psychoanalysis, psychodynamic, cognitive, and behavioral therapies to manage and cure the patient’s psychiatric disorder.
| CPT Code | Summary | Duration |
|---|---|---|
| 90832 | The code denotes that the provider used psychotherapy (lasting more than 35 minutes) to treat a patient’s psychiatric disorder. He may use verbal communication and interaction (e.g., talk therapy) to change the patient’s thoughts, behavior, and emotions. | 16 – 37 minutes |
| 90833 | This is an add-on CPT code for substance abuse treatment. It is used when the provider performs individual psychotherapy (lasting longer than 35 minutes) to treat the patient’s psychiatric disorder. The psychotherapy is performed in the same session as an evaluation and management service to expedite treatment. | 16 – 37 minutes |
| 90834 | This code is used when the provider performs psychotherapy (lasting more than 50 minutes) to treat a patient’s psychiatric disorder. He may use verbal communication and interaction (e.g., talk therapy) to change the patient’s thoughts, behavior, and emotions. | 38 – 52 minutes |
| 90836 | This is an add-on rehab CPT code and is used when the provider performs psychotherapy (lasting longer than 50 minutes) to treat the patient’s psychiatric disorder. The psychotherapy is performed in the same session as an evaluation and management service to ensure quick recovery. | 38 – 52 minutes |
| 90837 | Substance abuse CPT code 90837 is reported when the provider uses psychotherapy to treat a patient’s psychiatric disorder. The session lasts over 53 minutes and includes several techniques to manage the patient’s behavior, thoughts, and emotions. | 53+ minutes |
| 90838 | The code is reported for an add-on psychotherapy (lasting over 53 minutes) to treat the patient’s psychiatric disorder. The service is offered in addition to an evaluation and management visit on the same day to expedite healing. | 53+ minutes |
CPT Codes 90846, 90847, 90849 – Family Psychotherapies
Family psychotherapies or counseling have proven to be effective when the patient under treatment is an adolescent. Getting the family involved in the therapy ensures continuous support, helps identify the root causes, and paves a pathway for steady recovery. Below are the common substance abuse CPT codes that report family psychotherapies.
CPT Code 90846 – Family Psychotherapy without Patient
This substance abuse CPT code is used to tell the insurance payers that the provider met and counseled the patient’s family in the absence of the patient. Guidance was offered on the patient’s psychological condition and its management and treatment.
CPT Code 90847 – Family Psychotherapy with Patient
Substance abuse CPT code 90847 is similar to code 90846, but the patient is present here. Family psychotherapy with the patient is usually performed when individual psychotherapies become insufficient, and the provider feels the need to involve the family members to ensure the efficacy of the treatment plan.
CPT Code 90849 – Family Psychotherapy in Group
Lack of time could be one primary reason for performing group family psychotherapy and reporting substance abuse CPT code 90849. The provider gathers a few families whose member(s) are undergoing substance abuse treatment and conducts a session with them to help them understand and cope with their family members’ psychiatric disorders.
CPT Code 90853 – Group Psychotherapy
Group psychotherapies can be an effective way to foster support and social skills in patients suffering from similar mental health conditions after substance abuse. It can help them stay on track, enhance communication, and regain confidence as they prepare for a life outside the rehabilitation center.
90853 is a time-based rehab CPT code and denotes that the provider performed psychotherapy with 12 patients or less to treat their psychiatric conditions. The people in the group are not acquainted with one another. It helps them discuss their issues anonymously and without judgment. The provider leads the session, which lasts between 45 and 60 minutes.
Rehab CPT Codes for Evaluation and Management
CPT codes for evaluation and management (E/M) visits capture everything, from initial health assessments to follow-ups and timely medication management. These visits are scheduled throughout the patient’s care cycle and include diagnosis, preventative care, treatment, and rehabilitation in the case of relapse.
Therefore, the rehab CPT codes for E/M visits are categorized into new patient and established patient code ranges. These are as follows.
CPT Codes 99202-99205 – New Patient E/M Visits
Providers at rehabilitation centers must refer to this CPT code range when they meet a new patient in an office or outpatient setting and perform varying degrees of decision-making – from straightforward to high-level.
The codes must be assigned according to the time spent with the patient. For example, use code 99204 for an E/M visit that lasts 45 minutes or more.
CPT Codes 99212-99215 – Established Patient E/M Visits
The rehab CPT code range 99212-99215 is handy when the provider meets a returning patient. The timed evaluation and management visit may include changing the treatment plan, additional diagnosis, or recommending new avenues for managing the condition.
Again, the codes are assigned based on the level of decision-making and the time spent with the patient. For example, CPT code 99213 is reported when the provider meets a returning/established patient for 20 minutes or more, and the medical decision-making is of a ‘low level’.
Rehab CPT Codes for Medication Management
Inpatient and outpatient treatments for substance abuse often involve the administration of medications like mood stabilizers, psychedelics, anti-depressants, anti-psychotics, or anxiolytics.
The purpose of coupling medications with psychotherapies is to enhance the effects of each and ensure that the patient receives holistic medical care to recover from the addiction. The substance abuse CPT code mentioned below is widely reported at rehab centers when providers seek reimbursement for the pharmacological management of medications.
CPT Code 90863 – Pharmacological Management with Psychotherapy
90863 is a commonly reported rehab CPT code. Providers use it to denote that they prescribed, reviewed, or altered (increased or decreased the dosage) medication in the same session in which psychotherapy was performed.
Substance Abuse CPT Codes for Clinical Assessments
Comprehensive psychological and neurological clinical assessments are performed on people suspected to be suffering from substance use disorders.
These detailed examinations help the provider understand the patient’s history of substance use, their daily intakes, and the effects it has on their physical, mental, and emotional well-being.
Moreover, it allows the provider to formulate an effective treatment plan to cure the patient’s condition or counsel them if the patient is at risk of substance use disorder. The following substance abuse CPT codes capture such clinical assessments.
CPT Code Range 96116-96146 – Psychological and Neuropsychological Testing
This vast selection of substance abuse CPT codes covers a range of clinical assessments. The provider may perform cognitive performance tests, assess a patient’s thinking, reasoning, judgment, emotions, and behavior, or conduct detailed psychological or neuropsychological tests.
Some tests may even be scored or performed electronically, after which the provider interprets the results and prepares detailed reports. The test results are shared with the patient, family, and caregivers to either mitigate the risks or treat the addiction/disorder.
| CPT Code Ranges | Category |
|---|---|
| 96116 – 96127 | Neurobehavioral Status Examination |
| 96130 – 96133 | Psychological and Neuropsychological Testing Evaluation Services |
| 96136 – 96139 | Psychological and Neuropsychological Test Administration and Scoring |
| 96146 | Psychological and Neuropsychological Testing with Automated Administration and Scoring |
Rehab CPT Codes for Group Therapies
Group therapies targeting patients’ physical well-being are as important as group psychotherapies. Combining both ensure that patients recover holistically through shared experiences and learn from their peers to develop coping skills for managing substance use disorders. The following rehab CPT code is commonly used when the provider leads physical exercises for a group.
CPT Code 97150 – Rehabilitation Group Therapy
Rehab CPT code 97150 falls under ‘Physical Medicine and Rehabilitation Therapeutic Procedures’. It is used when the providers at the rehab center supervise and direct physical therapies (exercises) for a group of recovering patients. The goal of these group therapies in a rehabilitation center is to ensure that the patients regain physical strength after a long battle with drug/alcohol addiction.
Bottom Line
In this blog post, we have limited our angle to capture the most common substance abuse and rehab CPT codes in 2024. However, coding for rehab services and substance abuse treatment is more extensive and includes a range of Healthcare Common Procedure Coding System (HCPCS) codes—H0001 to H2037.
These 92 HCPCS codes cover medication administration, training and development, support sessions, foster care, prenatal care, and many more services that are essential for the treatment of substance use disorders and the ones indirectly affected by them.
However, to avoid stress, you can outsource rehab medical billing services to a professional billing company like MediBill MD. Their AAPC-certified coders are proficient in all standardized coding systems, including CPT, HCPCS, and ICD, saving you the hassle.
Frequently Asked Questions
