Skip to content Credex Healthcare provides expert substance abuse billing services all over the United States. As a company that provides specialized substance abuse billing services, we understand the exact CPT codes, modifier rules, documentation standards, and payer policies governing substance abuse reimbursement. We handle your entire billing cycle so that the revenue you earn from your clinical work is reliably deposited into your bank account on time. This includes intensive outpatient programs, substance treatment programs, peer recovery experts, and solo addiction centers.
We make sure the coding is correct, get the necessary pre-approvals, and help you stay in compliance with all regulations, so you can focus on taking care of your patients. We offer customized billing systems to help you structure and grow, whether you work alone or as part of a larger substance abuse network.
First-Pass Claim Acceptance Rate Across Payers.
Hrs. Average Claim Submission Turnaround Post-Documentation.
Public and Private Insurance Payers.
Telehealth Billing Compliance Across All Active Payer Contracts.
Concerning substance abuse claims, billing is beyond code assignment. Because substance abuse billing requires this, Credex Healthcare operates differently. Every claim that leaves our system has been through 4 major checkpoints before submission. Whether the code is for a diagnostic evaluation or individual alcohol counseling, we make sure the CPT code matches the time that recorded in the clinical note.
We make sure that any same-day payment for psychiatric diagnostic evaluation code includes the right add-on code, and that separate paperwork supports each service. We double-check that telehealth claims have the right place-of-service code and that the patient location modifier is used as required by the payer’s telehealth policy. We also make sure that common-use documentation is accurate for medication-assisted treatment.
Our substance abuse billing services in the USA cover the following:
We prepare and electronically submit substance abuse claims within 24 to 48 hours of session documentation, applying the accurate CPT codes, time-based modifiers, telehealth place-of-service codes, and ICD-10 codes for substance dependence verified against the clinical record before every transmission.
We credential and enroll addiction psychiatrists, LCSWs, LPCs, and LMHCs with Medicare, Medicaid, and commercial payers, managing recredentialing cycles and panel additions to keep billing active and uninterrupted.
Every denied substance abuse claim receives a root-cause review within 24 hours. Whether the denial is a time-documentation deficiency, a telehealth policy violation, a medical-necessity dispute, or an authorization gap, we appeal with supporting clinical evidence well within the payer deadline.
Our expert coders audit session notes, psychological testing records, and intake evaluations to confirm that billed CPT codes match documented service time and content, and that no billable service is left uncaptured in your charge-entry workflow.
We manage prior authorization requests for psychiatric evaluations, intensive outpatient services, and MAT where commercial plans or Medicaid programs require pre-approval before reimbursement.
Credex Healthcare tracks substance abuse billing rules by payer type, state Medicaid program, and telehealth policy update, so your claims are always submitted with the documentation and code set that the right payer requires on the right claim.
Our team knows that Medicare has its own rules about the kind of paperwork and medical necessity that are needed for IOP and treatment programs. Similarly, we are up to date on the commercial payers that have their own rules in covering telehealth substance abuse visits that may be very different from what the same plan pays for in-person sessions.
We apply CMS guidelines for psychiatric evaluation and testing and addiction treatment programs when E&M and therapy services are billed on the same date.
We manage state-specific Medicaid substance abuse billing requirements, including session authorization limits, covered diagnostic criteria for reimbursable services, and managed care organization submission rules that vary across state programs.
We handle prior authorization, benefit verification, and claims submission for commercial substance abuse services under BCBS, Cigna, Aetna, UnitedHealthcare, and regional carriers, applying each payer's current substance abuse coverage and telehealth policies.
We bill telehealth substance abuse sessions using the correct place-of-service codes, patient location modifiers, and principal domain rules for each payer and jurisdiction, keeping your telehealth revenue compliant and collectible.
Most substance abuse claim denials are not random. They trace back to five specific failure points that a specialist billing team prevents before a single claim leaves the practice. Credex Healthcare eliminates every one of these failure points through a structured pre-submission workflow built specifically for substance abuse billing.
We verify that every psychologist billing under the group NPI is individually enrolled with the target payer, that taxonomy codes are correctly assigned, and that Medicare and Medicaid enrollment records are current before any claim is submitted.
Our coders confirm that each CPT code is matched to the correct documented service time, that add-on codes are applied when E&M services are billed on the same date, and that psychological testing codes reflect separate administration, scoring, and interpretation components.
We audit session notes, intake evaluations, and psychological testing records to verify that time-based documentation meets the threshold for the CPT code selected and that the ICD-10 diagnosis codes establish medical necessity at the payer's required level of specificity.
We manage authorization requests for psychological testing, intensive outpatient programs, and any substance abuse service category requiring pre-approval, tracking approval timelines and session authorization limits to prevent post-service denials on authorized visits.
We apply the correct POS codes, patient location modifiers, and originating site rules to every telehealth substance abuse claim and update our submission workflow in real time as payer telehealth policies evolve.
AR Follow-Up
All open substance abuse claims are tracked through a structured AR process by payer and aging bucket, with escalation protocols for any claim exceeding 45 days without payment or formal payer determination.
We submit substance abuse claims with verified CPT codes matched to documented session time, correct add-on codes, and accurate ICD-10 diagnosis coding, targeting first-pass acceptance and eliminating the revenue lost to preventable time-based coding errors.
Our substance abuse coding specialists review every session note and testing record to ensure CPT codes reflect the actual documented service time and content, capturing the full legitimate reimbursement your clinical work supports.
Prior Authorization Management
We initiate and track prior authorizations for psychological testing and specialty substance abuse services, preventing post-service denials on authorized episodes and managing session limit tracking across all active payer authorizations.
Every denied substance abuse claim is reviewed within 24 hours, categorized by root cause, and either corrected and resubmitted or formally appealed with supporting clinical documentation submitted before the payer's filing deadline.
We credential psychologists and licensed clinical psychologists with Medicare, Medicaid, and commercial payers, managing re-credentialing cycles and new provider enrollment to ensure every session your clinicians conduct is billable from day one.
Monthly reports cover your clean claim rate by CPT code, denial breakdown by payer and root cause, telehealth billing performance, AR aging, and net collections trend so you always know exactly where your revenue stands.
Substance abuse and Substance abuse Revenue Cycle Expertise
Provider Enrollment Coverage for All Active Substance abuse Rosters
HIPAA Compliance Rate Across All Billing Operations
Dedicated Billing Support for Substance abuse Practices
Customized Billing Workflows for Every Substance abuse Practice Model
Licensed Psychologist
Marsh
I had been under-coding my therapy sessions for almost two years without knowing it. I was billing 90834 for sessions I documented at 60 minutes because nobody had ever told me the time thresholds that separate it from 90837. Credex caught the trend in the first week of the audit and fixed it from then on. I wish I had called them two years earlier because the change in income was so big.
Neuropsychological Testing Practice
Greer
Neuropsychological testing billing is a specialty within a specialty, and there aren’t many billing companies that know the difference between 96130 and 96132 or how to correctly bill the management parts separately. Credex got it right immediately. Our testing reimbursements improved and our denial rate on testing claims dropped from 24% to under 5% in the first quarter they managed our billing.
Group Therapy Practice
Connell
Managing billing for seven clinicians across two Medicaid managed care organizations and four commercial payers was overwhelming our front office. It was hard to keep track of because each provider had different enrollment levels and session authorization limits. Credex took it all as their own. Within 60 days, our AR aging got a lot better, and we stopped losing sessions because of permission limit overruns, which we hadn’t been keeping track of properly before.
Telehealth Substance abuse Practice
Kapoor
Since telehealth is the main part of our business, getting the POS codes and telehealth policy right is very important for our billing. When New York Medicaid changed the rules for telehealth billing, our old billing business didn’t notice at all. Before the new deadline, Credex made the changes to our process, and since then, our telehealth claim acceptance rate has stayed above 97%.
Practice Director
Mark
At a community substance abuse center, we serve a predominantly Medicaid population and our billing volume is high. We needed a billing partner who knew about the different Medicaid session limits in each state, the diagnostic criteria, and the paperwork that was needed for court-ordered psychological exams. From the start, Credex knew what kind of payers we had, and in the first two billing cycles, our rejection rate dropped from 21% to 6%. We have really been unable to help people because of this.
Practice and Payer Mix Assessment
For substance abuse practices, this assessment focuses specifically on time-based coding accuracy, telehealth billing compliance, psychological testing billing completeness, and any active credentialing or enrollment gaps across your payer contracts.
Credentialing and Payer Enrollment
We verify that every rendering provider in your practice is individually credentialed and enrolled with each payer. We start the registration process right away for new providers or group practices that want to join, and we keep track of the approval process until it's done. This way, billing can start as soon as the new provider sees their first patient.
Documentation and Authorization Workflow Setup
We work with your clinical and administrative team to set up documentation checkpoints for meeting CPT time-thresholds, making sure that telehealth point-of-sale (POS) codes are correct, keeping track of prior authorizations for specialty services and psychological tests, and making sure that ICD-10 specificity requirements are met.
Clean Claim Submission
Every substance abuse claim is checked to make sure that the CPT code matches the recorded session time, that all the add-on codes are filled out, that the right telehealth place-of-service and modifier codes are used, that the ICD-10 diagnosis codes are specific, and that the proper prior authorization attachment is made before the claim is sent electronically.
Denial Management & Follow-Up
Within 24 hours of receiving them, denied substance abuse claims are looked over and put into groups. Our denial team can tell the difference between time-documentation disputes, telehealth policy violations, authorization gaps, medical necessity denials, and payer adjudication mistakes. They then fix each problem.
Reporting & Ongoing Optimization
Performance reports are sent to you every month and include information on your clean claim rate by CPT code, denials broken down by payer and root cause, telehealth billing performance, AR aging by payer, and net collections trend. Every month, we go over this data with your leaders and make changes to the payment process to fit each payer.
Substance abuse billing requires a level of specialty-specific knowledge that generalist operations simply do not maintain. At Credex Healthcare, we know that 90837 needs more than 53 minutes of recorded psychotherapy time, not just a note saying that the session was therapeutic. As our team also learns, Medicare needs separate accounting for the administration and interpretation parts of a psychological test under 96130 instead of bundled reporting. This means that getting full payment or leaving $300 on the table every episode is important.
There is a 97% acceptance rate for telehealth and a 70% acceptance rate. The difference is knowing how each business payer in your market has changed their telehealth billing policy in the last 90 days.
Our billing team maintains active knowledge of psychotherapy CPT time thresholds, psychological testing billing components, telehealth compliance requirements, Medicare substance abuse documentation standards, and Medicaid session authorization rules across all active state programs.
You work with a named substance abuse billing account manager who knows your providers, your payer contracts, and your session mix. Your account manager will let you know before it changes a claim if a payer changes their telehealth policy or a Medicaid managed care contract changes the permission requirements.
Every month, we send each client a full report that includes the number of claims by CPT code, the first-pass acceptance rate, the breakdown of denials by root cause, the performance of telehealth billing, the amount of money owed by payer, and the net collections trend. The report also includes plain-language explanations of what the numbers mean for your practice.
Credex Healthcare does all its substance abuse billing in a fully HIPAA-compliant setting that includes encrypted EHR integration, secure claim transmission, and access controls on all patient records that are regularly checked. Privacy is not a checkbox when it comes to substance abuse bills.
Our certified billing specialists are available to support your substance abuse practice whether you are managing telehealth sessions, group therapy, or time-based coding. From quick clarifications to urgent claim issues, our experts are just a call away.
Credex Healthcare gives approved substance abuse practices a free audit of their billing. The audit looks at how you use CPT codes and how accurate your time-based documentation is. It also looks at your denial rate by payer and code group, how well you follow the rules for telehealth billing, any gaps in enrollment or credentialing, and your current AR aging profile. There is no obligation after the audit, and almost every practice that does it finds an income gap that can be closed in the first session. You just need to decide how long you’re willing to wait.
Selecting and verifying CPT codes like 90791 for psychiatric exams is part of substance abuse medical billing. Other tasks include management and revenue cycle tasks for clinical service reimbursement. It includes verifying the patient’s insurance, verifying the provider’s credentials, keeping track of prior authorizations, preparing and sending claims, posting payments, managing rejections, and following up on accounts outstanding.
When it comes to substance abuse, the most popular CPT codes are for evaluations (like 90791), psychotherapy (like 90832, 90834, and 90837), and psychological tests (like 96130 to 96133). It is not possible to bill for both treatment and the evaluation code on the same day. There are also special codes for technicians who work with psychological testing (96136, 96137). To prove medical necessity, you need accurate ICD-10 numbers. This is especially important now that payers are auditing substance abuse claims more often.
Five major issues must be addressed in a psychological practice to limit claim denials and avoid audits. To support the CPT code, session notes should include specific start and end times or total face-to-face time, verify payer credentials before patient appointments and review psychological testing prior authorization requirements before arranging exams. Also, check telehealth billing workflows for revised place-of-service codes and modifiers. Monthly CPT code and payer rejection patterns can reveal paperwork or payer policy difficulties.
Medicare, Medicaid, and private insurers have improved their coverage for substance abuse treatments through telehealth since 2020. As long as Congress doesn’t act before 2025, Medicare will let people get treatment and evaluations over the internet with certain codes. Some state Medicaid programs make changes made during the pandemic permanent while putting other limits on the program. Different commercial insurers have different rules about substance abuse telehealth equity. Some will pay for it all, while others will need to be approved first. To avoid having their claims denied for coding errors, telehealth substance abuse offices need to know how to bill each payer.
The billing industry is rapidly evolving. By the year 2025, the system and tools used
Billing companies ensure compliance with HIPAA and other regulations by being legitimate and reliable. Every
At Credex Healthcare, we know how frustrating it is when claims are denied. That is
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