Submitting Claims for Suboxone Therapy

Suboxone is a drug that is used in treating drug addiction. It is very effective and does not require inpatient treatment. Physicians must be certified to prescribe Suboxone and have other guidelines they must follow.

For example, on the first visit the patient must come in to their appointment in the early stages of withdrawal. The dr must document their condition and then give them the first dose of Suboxone in the office. Then they have to wait for the drug to begin to take effect. The patients condition is documented again and instructions are given.

The Suboxone works much like Opoids, but unlike Opoids the patient can be weaned down and in most cases completely off of the Suboxone. This can all be done with outpatient medical visits and eliminates the need for an inpatient stay.

Sounds good so far, the problem comes in when you submit the claims to the insurance carriers. Since the diagnosis begins with 30*.** the insurance carriers pick the claim up as mental health. Many carriers handle their mental health claims differently than their medical claims and some even subcontract their mental health to a different insurance carrier. Most mental health services require preauthorization. However, suboxone therapy is a medical service and is coded as a medical office visit.

Since Suboxone therapy is a fairly new treatment many insurance carriers do not know what to do with these claims. We are finding that we have to educate each carrier as to what Suboxone is and go thru a huge process with them in order to get the provider reimbursed properly for their services. One carrier in particular was telling us when we called that preauthorization was not required, but they were denying all claims stating no preauth was obtained. After 6 months of phone calls we finally got it straightened out. They had to make some adjustments to their system to allow the claims to process correctly but the provider got reimbursed for all visits.

We still have some insurance carriers not processing the claims correctly but most are starting to get the hang of it. We just keep plugging along and educating the carriers on what Suboxone therapy is. After all, in the long run it saves them money on the inpatient stay.

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8 Responses to “Submitting Claims for Suboxone Therapy”

  1. With This Diet I Shed Thirty Póunds in Only a Month Says:

    Hi, interesting post. I have been pondering this topic,so thanks for sharing. I’ll likely be coming back to your blog. Keep up great writing

  2. Kathy Burke Says:

    Were you filing the claims as E/M plus prolonged physician services codes? Or were you using an S code or H code for detoxification services?

  3. In need of help Says:

    Hi,

    I am new to billing Suboxone and am getting no help from the insurance companies, would it be possible to see an example of a claim form?

    • solutionsmedicalbilling Says:

      Due to HIPAA I can’t do a claim form. What specifically are you trying to bill for? E&M? What CPT code?

      • In need of help Says:

        H0047, J8499 then there are NDC codes for 2mg and 8mg, but do I bill all these codes for one date? And we dispense doses each day so I’m still unclear on how to bill. I was thinking if I could just see a nondescript claim without any personal information other than how to set up the claim.

        Thank you you for getting back to me.

      • solutionsmedicalbilling Says:

        Are you using a UB04 form to bill? Or a CMS 1500? Also what are the specific reasons for denial? It appears that you are using non specific HCPCs codes. I think that may be the problem.

      • In need of help Says:

        I have not billed yet to have denials, i am unsure about how to bill. I am using CMS-1500

  4. solutionsmedicalbilling Says:

    What specific services are you billing for and what provider is rendering? (MD, DO?) We bill for both MDs and DOs that provide suboxone services. We don’t use either H0047 or J8499. Most billing is E&M codes.


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