Streamline your SUD treatment process by incorporating telehealth and effectively manage billing for virtual care services.

1. Telehealth In SUD Treatment: Billing For
Virtual Care Services
In the Behavioral Health and Substance Use Disorder (SUD) industry, telehealth has
become a crucial tool for ensuring patients receive essential care. However,
navigating the billing process for telehealth services in Addiction Treatment
Centers requires careful attention to detail. This guide provides comprehensive and
updated billing guidelines to facilitate accurate claims processing.
Implementing Changes to Patient Intake
and Verification of Benefits (VOB)
Processes
A. Patient Intake Process Updates
When considering adopting telehealth services, revising the patient intake process is
essential. This involves adding specific questions related to telehealth and the
patient’s plan into the VOB process. The following questions are essential to gather
pertinent information related to telehealth and the patient’s insurance plan:

2. Telehealth Coverage Inquiry:
 Ask whether the patient’s insurance plan provides coverage for telehealth services.
 Inquire about any specific conditions related to telehealth coverage.
Authorization Requirements:
 Determine if the insurance plan requires prior authorization for telehealth sessions.
 If authorization is necessary, inquire about the process for obtaining approval.
Telehealth Benefits Variations:
 Understand that telehealth benefits may differ among payers and plans.
 Ask about any specific requirements or restrictions associated with telehealth
benefits under the patient’s plan.
Required Modifiers:
 Inquire about any specific modifiers the insurance company requires for telehealth
claims.
 Confirm whether modifiers like 95 or GT are needed and under what circumstances.
In-Network or Out-of-Network Status:
 Verify whether the treatment center is considered in-network or out-of-network for
telehealth services under the patient’s plan.
 If applicable, gather information on any variations in coverage or costs based on
network status.
Claim Submission Information:
 Confirm the accurate claims submission information, including the Claims Address
and Payer ID.
 Ensure that all details align with the insurance company’s requirements for telehealth
claims.
Documentation Requirements:
 Ask about any specific documentation or information the insurance company expects
to accompany telehealth claims.
 Verify whether there are unique requirements for addiction treatment services
provided through telehealth.
Reference and Confirmation:
 Obtain a reference number for the VOB call and record it for future reference.
 Document the date, time, representative name, and reference number in the patient’s
records for traceability.

3. B. Recommended VOB Script for SUD Telehealth
Authorization
A standardized script for obtaining authorization from insurance companies is crucial
to transition to telehealth successfully. This script includes key steps such as
verifying demographics and insurance information and obtaining approval for
telehealth sessions. It also emphasizes recording essential details like reference
numbers and claim submission information.
C. Applying the Correct Modifiers
 Professional Claims
For professional claims, it’s advisable to use appropriate CPT codes and apply a
modifier with the correct place of service code (02) in most cases. The modifier 95
signifies synchronous telemedicine service through real-time interactive audio and
video. However, it’s emphasized that modifier requirements may vary among payers,
making it essential to verify for each patient.
Billing Codes
Several billing codes are relevant to telehealth in addiction SUD treatment services,
including:
 99441: Telephone E/M service for 5–10 minutes of medical discussion
 99442: Telephone E/M service for 11–20 minutes of medical discussion
 99443: Telephone E/M service for 21–30 minutes of medical discussion
 90832: Psychotherapy for 30 minutes with a patient
Place of Service (POS) Codes
Important POS codes for telehealth include:
 POS 02: Telehealth provided other than in the patient’s home
 POS 10: Telehealth provided in the patient’s home
1. Institutional Claims
In institutional claims, where the Place of Service is not on a UB-04, adding a
modifier of GT is typical for telehealth. This modifier indicates services rendered via
telecommunications.
Tips for Successful Billing:
Here are vital tips to ensure compliance with billing guidelines for Telehealth in
Substance Use Disorder (SUD) Treatment :

4.  Documentation Standardization:
Implement standardized documentation procedures for patient intake and
Verification of Benefits (VOB). Consistent and accurate record-keeping is essential
for successful claims processing.
 Script Implementation:
Implement the recommended script for obtaining telehealth authorization
consistently. Not only this, but you should also ensure that all necessary information,
including demographics and insurance details, is collected during calls to insurance
companies.
 Regular Updates:
Stay informed about changes in federal and state regulations related to telehealth
billing. You should regularly update the internal processes to align with changing
guidelines to avoid compliance gaps.
 Modifier Verification:
Double-check and verify the correct application of modifiers (e.g., 95 or GT) based
on payer requirements for professional and institutional claims. Thereby, the
consistent application helps prevent claim denials.
 Claim Submission Review:
You should focus on establishing a robust review process for submitted claims. Such
a review process will ensure that all required information, such as reference numbers
and claim submission details, is accurate before submission to minimize errors.
 Technology Integration:
If utilizing billing software, ensure the system is configured correctly for SUD
telehealth services. Leverage available technology to streamline the billing process
and enhance accuracy.
 Regular Audits:
Conduct regular internal audits of billing practices to identify and rectify deviations
from established guidelines. Proactive monitoring helps prevent issues before they
escalate.

5. How do you ensure Virtual Care Services Billing
Compliance?
Failure to adhere to the above billing guidelines for telehealth in substance use
disorder (SUD) treatment can have significant consequences for Addiction
Treatment Centers. Non-compliance may result in delayed or denied claims, leading
to financial losses for virtual centers. Without proper implementation of changes to
patient intake and Verification of Benefits (VOB) processes, there is a high possibility
of inaccuracies in billing, potentially resulting in claim rejection. Moreover, applying
the correct modifiers on professional and institutional claims may lead to claim
denials by insurance providers. This impacts the center’s revenue and also disrupts
the continuity of care for patients in need of addiction treatment services.
Outsourcing SUD billing processes to experts like 24/7 Medical Billing Services is
the optimal solution in such situations. By outsourcing the billing tasks, Addiction
Treatment Centers can focus more on delivering high-quality virtual care services
with confidence that their billing processes are in capable hands. This collaborative
approach optimizes operational efficiency and reinforces the commitment to
providing uninterrupted, quality care to those in need of SUD treatment services.
About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service provider
catering services to more than 43 specialties across the entire 50 states. You can
rely on us for end-to-end revenue cycle management. We guarantee up to 10-20%
increase in the revenue with cost reduction of your practice for up to 50%.
Call us today at 888-502-0537 to know more on how we can help boost profitability
for your practice.
Media Contact –
24/7 Medical Billing Services,
28405 Osborn Road,
Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: info@247medicalbillingservices.com