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Home Resources Medicaid Billing for OASAS Services

Chemical Dependence Services and Corresponding Billing Codes

Service Type /
Statutory Authority
Rate
Code
HCPCS Code
Current Procedural Terminology Code
(CPT / Procedure Code)
Revenue Code

Medically Managed Withdrawal

Article 28, Public Health Law (PHL) and Article 32, Mental Hygiene Law (MHL)

4800

H0009 Alcohol and /or drug services, acute detoxification

(hospital inpatient)

Codes based on severity of presenting conditions and physician bedside / unit minutes:

Initial Hospital Care:

  • 99223 (high severity – 70 bedside / unit minutes))

Subsequent Hospital Care:

  • 99233 (high complexity: significant complication, new problems, 35 bedside / unit minutes)

0100 All inclusive room and board plus ancillary

0101 All inclusive room and board

0116 Detox prvt

0126 Detox semi prvt two beds

0136 Detox semi prvt  three and four bed

0146 deluxe room

0156 Detox Ward

Medically Supervised Inpatient Withdrawal Article 28 only

Observation days were not necessary / provided.
4801 H0008 Alcohol and /or drug services, sub- acute detoxification

(hospital inpatient)

Codes based on severity of presenting conditions and physician bedside / unit minutes:

Initial Hospital Care:

  • 99221 (low severity – 30 bedside /unit minutes)
  • 99222 (moderate severity – 50 beside / unit minutes)

Subsequent Hospital Care:

  • 99231 (low complexity: stable, recovering, improving and 15 minutes bedside / unit minutes)
  • 99232 (moderate complexity: minor complications, inadequate response to therapy 25 bedside / unit minutes)
See revenue codes associated with rate code 4800

Medically Supervised Inpatient Withdrawal Article 28 only

After having received one observation day the patient is placed at the MSIW level of service.
4802

Medically Supervised Inpatient Withdrawal Article 28 only

After having received two observation days the patient is placed at the MSIW level of service.
4803

Medically Supervised Inpatient Withdrawal

Article 32 MHL only

4220

H0008 Alcohol and/or drug services,  sub acute detoxification (hospital inpatient)

H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient.)

See Medically Managed Withdrawal

See revenue codes associated with rate code 4800

Medically Supervised Outpatient Withdrawal

Article 28 PHL and Article 32 MHL

4279

H0014 alcohol and/or drug services;  ambulatory detoxification

H0007 alcohol and/or drug services (crisis intervention outpatient)

90805 (individual psychotherapy 20-30 minutes, with medical evaluation and management services.)

90807 (individual psychotherapy 45-50 minutes, with medical evaluation and management services.)

90809 (individual psychotherapy 75-80, with medical evaluation and management services.)

0519 Clinic Other

Medically Supervised Outpatient Withdrawal

Article 32, MHL only

4221

0529 Free standing clinic other

Chemical Dependence Inpatient Rehabilitation

Article 32 MHL only

4204

H2036 alcohol and/or drug treatment per diem

See Medically Managed Withdrawal

1000 Accommodations  BH R&B General classification for Behavioral Health accommodations at specified behavior health facilities

0128 R&B Semi private two beds – rehabilitation

0138 Semi private three and four beds – rehabilitation

Chemical Dependence Inpatient Rehabilitation,  State Operated Addiction Treatment Center

Article 32 MHL only

4202

H2036 alcohol and/or drug treatment per diem

Chemical Dependence Inpatient Rehabilitation

Article 28 PHL and Article 32 MHL

2957

H2036 alcohol and/or drug treatment per diem

Chemical Dependence Inpatient Rehabilitation

Article 32 MHL only

4213

H2036 alcohol and/or drug treatment per diem

Chemical Dependence Residential Rehabilitation Services for Youth (RRSY)

Article 32 MHL Only

4210 H2036 alcohol and/or drug treatment per diem See Medically Managed Withdrawal

0100 All inclusive room and board plus ancillary

0110 General Classification Room and Board (private)

0120 General Classification Room and Board (two beds)

0130 General Classification Room and Board (three and four beds)

Chemical Dependence Outpatient Clinic

Article 32 MHL only

4214 (assessment at least 30 minutes)

H0001 Alcohol and / or drug assessment

H0002 behavioral health screening to determine eligibility for admission to treatment program.

90801 (psychiatric diagnostic interview examinations)

0529 - Other Freestanding Clinic,

Chemical Dependence Outpatient Clinic

Article 32 MHL only

4215 (individual session at least 30 minutes)

H0047 Alcohol and / or drug abuse services

H0004 Behavioral Health counseling and therapy, per 15 min.

90804 (individual psychotherapy 20-30 minutes)

90806 (individual psychotherapy 45-50 minutes)

90808 (individual psychotherapy 75-80 minutes)

Chemical Dependence Outpatient Clinic

Article 32 MHL only

4216 (group session at least 30 minutes)

H0005 alcohol and / or drug services group counseling by a clinician

90853 (group psychotherapy)

Chemical Dependence Outpatient Clinic

Article 28 PHL and Article 32 MHL

4273 (assessment at least 30 minutes)

See Article 32

90801 (psychiatric diagnostic interview examinations)

0510 – Clinic General Classification

Chemical Dependence Outpatient Clinic

Article 28 PHL and Article 32 MHL

4274 (individual session at least 30 minutes)

90804 (individual psychotherapy 20-30 minutes)

90806 (individual psychotherapy 45-50 minutes)

90808 (individual psychotherapy 75-80 minutes)

Chemical Dependence Outpatient Clinic

Article 28 PHL and Article 32 MHL

4275 (group session at least 30 minutes)

90853 (group psychotherapy)

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 28 PHL and Article 32 MHL

4276 (assessment at least 30 minutes)

H0001 Alcohol and / or drug assessment

90801 (psychiatric diagnostic interview examinations)

0907 Community Behavioral Health Program (Day Treatment)


0919 Other Behavioral Health Treatments / Services

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 28 PHL and Article 32 MHL

4277 (full day rehab at least four hours) 

H0015  alcohol and/or drug services intensive outpatient treatment (at least 3 hours/day  3 days/week)

90899 (unlisted psychiatric service or procedure) (Current CPT codes do not recognize duration of the four hour half day rehab)

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 28 PHL and Article 32 MHL

4278 (half day rehab less than four but at least two hours)

H2012

Behavioral health day treatment, per hour

90899 (unlisted psychiatric service or procedure) (Current CPT codes do not recognize duration of the two to four hour rehab days)

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 32 MHL only

4217 (assessment at least 30 minutes)

 

90801 (psychiatric diagnostic interview examinations)

0919 Other Behavioral health Treatments / Services

0907 Community Behavioral Health Program (day treatment)

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 32 MHL only

4218 (full day rehab at least four hours) 

H0015  alcohol and/or drug services intensive outpatient treatment (at least 3 hours/day  3 days/week)

90899 (unlisted psychiatric service or procedure) (Current CPT codes do not recognize duration of the four hour half day rehab)

Chemical  Dependence Medically Supervised Outpatient Rehabilitation

Article 32 MHL only
4219 (half day rehab less than four but at least two hours)

H2012 Behavioral Health day treatment per hour

90899 (unlisted psychiatric service or procedure) (Current CPT codes do not recognize duration of the two to four hour rehab days)

Chemical Dependency for Youth Outpatient Clinic

Article 28 PHL and Article 32 MHL

4283 (assessment at least 30 minutes)

H0001 Alcohol and / or drug assessment

H0002 behavioral health screening to determine eligibility for admission to treatment program.

90801 (psychiatric diagnostic interview examinations)

0529 - Other Freestanding Clinic

Chemical Dependency for Youth Outpatient Clinic

Article 28 PHL and Article 32 MHL

4284 (individual at least 30 minutes)

H0004 behavioral health counseling and therapy, per 15 minutes

90804 (individual psychotherapy 20-30 minutes)

90806 (individual psychotherapy 45-50 minutes)

90808 (individual psychotherapy 75-80 minutes)

Chemical Dependency for Youth Outpatient Clinic

Article 28 PHL and Article 32 MHL

4285 (group at least 30 minutes)

H0005 alcohol and / or drug services group counseling by a clinician

90853 (group psychotherapy)

Chemical Dependency for Youth Outpatient Clinic

Article 32 MHL only

4280 (assessment at least 30 minutes)

H0001 Alcohol and / or drug assessment

H0002 behavioral health screening to determine eligibility for admission to treatment program.

90801 (psychiatric diagnostic interview examinations)

0529 - Other Freestanding Clinic

Chemical Dependency for Youth Outpatient Clinic

Article 32 MHL only

4281 (individual at least 30 minutes)

H0004 behavioral health counseling and therapy, per 15 minutes

90804 (individual psychotherapy 20-30 minutes)

90806 (individual psychotherapy 45-50 minutes)

90808 (individual psychotherapy 75-80 minutes)

Chemical Dependency for Youth Outpatient Clinic

Article 32 MHL only
4282 (group, at least 30 minutes) H0005 alcohol and / or drug services group be counseling by a clinician 90853 (group psychotherapy)
MTP / Article 28, PHL and Article 32 MHL 1671 Free Standing Clinic

H0020 alcohol or drug services; methadone administration

J1230 injection Methadone

90862 Pharmacological Management 0529 Other Freestanding Clinic
MTP / Article 28 PHL and Article 32 MHL 2973 Hospital Based 0510 Clinic General Classification
Buprenorphine Article 28 PHL and Article 32 MHL 2531 (Low Dose 2-10 mg)

No Buprenorphine Specific Code. Providers may choose to use

J3490: unclassified drugs

or

H0033 Oral medication administration, direct observation

 

90862 Pharmacological Management 0529 Other Freestanding Clinic
0510 Clinic General Classification
Buprenorphine Article 28 PHL and Article 32 MHL 2532 (Medium Dose 12-20 mg) 90862 Pharmacological Management 0529 Other Freestanding Clinic
0510 Clinic General Classification
Buprenorphine Article 28 PHL and Article 32 MHL 2533 (High Dose 22-26 mg) 90862 Pharmacological Management 0529 Other Freestanding Clinic
0510 Clinic General Classification
Buprenorphine Article 28 PHL and Article 32 MHL 2534 (Max Dose 28+ mgs) 90862 Pharmacological Management 0529 Other Freestanding Clinic
0510 Clinic General Classification