Behavioral HealthHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 9, 2024

Drug testing covered in ASAM level 3.1 and 3.5 per diem bundles

Anthem embraces opportunities to foster collaboration efforts with care providers to help ensure proper coding and payment of claims. A recent review showed that drug testing claims are being submitted for members in treatment at residential treatment centers (RTCs) for substance use disorders (SUDs) for American Society of Addiction Medicine (ASAM) levels 3.1 and 3.5.

The Indiana Health Coverage Program (IHCP) Provider Reference Module for Behavioral Health Services states that drug testing is included in the bundle of services covered by the per diem payment for ASAM levels 3.1 and 3.5.

Table 3 ─ low-intensity residential treatment (ASAM level 3.1) billing guidance

Services included in per diem

Procedure code

Description

  • Individual therapy
  • Group therapy
  • Medication training and support
  • Case management
  • Drug testing
  • Peer recovery supports

H2034

Alcohol and/or drug abuse half-way house service, per diem

Table 4 ─ high-intensity residential treatment (ASAM level 3.5*) billing guidance

Services included in per diem

Procedure code

Description

  • Individual therapy
  • Group therapy
  • Medication training and support
  • Case management
  • Drug testing
  • Peer recovery supports
  • Skills training and development

H0010

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

ASAM 3.5 is considered medium-intensity residential treatment for adolescents.

Coverage for drug testing with service codes 80305, 80306, 80307, G0480, G0481, and G0482 are included in the per diem payment for RTC 3.5 level of care (procedure code H0010) and RTC 3.1 level of care (procedure code H2034) when the member is in active treatment in that level of care.

Anthem will soon ensure that the billing guidance related to drug testing during residential treatment set forth in the IHCP Provider Reference Module is being followed. Claims submitted that do not adhere to this guidance will be denied.

We are grateful for your care of our members and look forward to continued collaboration.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-065141-24

PUBLICATIONS: November 2024 Provider Newsletter