Addiction Medicine Billing Services —
MAT, Suboxone & Every SUD Code

They are two separate payment structures, not two ways of coding the same service. A SAMHSA-certified Opioid Treatment Program bills Medicare a medication-specific weekly bundle: G2067 for methadone, G2068/G2069 for oral/injectable buprenorphine, G2073 for naltrexone — each bundle includes dispensing or administration, toxicology testing, and counseling for that week. A non-OTP physician office prescribing buprenorphine under a standard DEA registration instead bills the office-based treatment (OBOT) bundle: G2086 for the first month of overall treatment management, care coordination, and counseling, G2087 for each subsequent month, and G2088 for additional 30-minute counseling increments beyond what G2086 includes. Since the 2023 elimination of the DATA-Waiver requirement, far more general and behavioral health practices are prescribing buprenorphine and need to bill the OBOT bundle correctly rather than defaulting to standard E&M codes that don't match the service actually delivered.

Federal regulation (42 CFR Part 8) restricts methadone for opioid use disorder treatment to SAMHSA-certified Opioid Treatment Programs — it cannot be prescribed from a general office setting the way buprenorphine can (methadone for pain management is a separate, differently regulated use). That means methadone dosing is never billed as a standalone drug or E&M charge; it is only billed through the OTP's weekly bundle. Practices that treat methadone like any other medication charge outside the OTP bundle structure are billing outside the regulatory framework the drug operates under, not just making a coding error.

Part 2 is a separate federal confidentiality statute for substance use disorder treatment records, with criminal penalty exposure that standard HIPAA violations don't carry. Historically, nearly every re-disclosure of Part 2-protected information — including to another treating provider for care coordination — required patient consent naming the specific recipient and purpose, which is stricter than HIPAA's treatment/payment/operations exception. A 2024 federal final rule aligned Part 2 more closely with HIPAA for TPO disclosures under a single general consent, but restrictions on using SUD records in legal proceedings and on certain re-disclosures still apply. We track Part 2 consent scope separately from standard HIPAA authorizations so claims-adjacent disclosures never outrun what the patient actually consented to.

Presumptive testing (80305–80307) is the immunoassay-based screen — the point-of-care cup or instrument that gives a positive/negative result by drug class. Definitive testing (G0480–G0483) identifies specific drugs and metabolites, typically via mass spectrometry, and is billed by the number of drug classes tested. The distinction is driven entirely by the testing methodology actually performed, documented on the lab requisition and result report — not by how clinically confident the ordering provider is in the result. Billing definitive-level codes for what was actually a presumptive screen is one of the most heavily audited patterns in addiction medicine, and we verify methodology against documentation before a testing code is ever assigned.

We benchmark each payer's prior authorization frequency, visit limits, and cost-sharing for SUD services against the comparable medical/surgical benefit that payer offers — for example, comparing SUD residential concurrent-review intervals against inpatient medical concurrent-review intervals for the same payer. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), a payer cannot impose materially stricter requirements on the SUD side. When we identify a systemic gap rather than a one-off denial, we file formal parity complaints with the payer and, where warranted, the state insurance department.

The American Society of Addiction Medicine defines levels of care from 0.5 (early intervention) through 4 (medically managed intensive inpatient), and each level carries different authorization requirements and billing structure. Office-based and outpatient levels bill standard E&M, counseling, and OTP/OBOT bundle codes. Facility-based levels — residential (3.1–3.7) and inpatient (level 4) — bill per-diem or per-service facility codes distinct from office-based physician billing, and typically require prior authorization with concurrent utilization review. We identify the ASAM level a program is actually delivering and bill the corresponding structure, not a default outpatient framework applied to a residential program.

No. Medicare pays OTPs through the medication-specific weekly bundle codes (G2067 methadone, G2068/G2069 buprenorphine, G2073 naltrexone). Many state Medicaid programs instead use a per-diem code such as H0020 (methadone administration, per diem) with their own state-specific billing rules and rates. Billing the Medicare bundle structure to a Medicaid program, or vice versa, produces a mismatch against that payer's actual billing rules. We bill each OTP claim to the specific code set and cadence the patient's payer — Medicare or the relevant state Medicaid program — actually requires.