Although insurance coverage of addiction medicine is limited, there are an increasing number of fee codes that are currently available to help support doctors who are treating patients with substance use disorders (SUDs).
Addiction Medicine Fee codes & Guidelines:
The following list are the available MSP fee codes for Addiction Medicine:
1. 13013: Assessment for Induction of Opioid Agonist Treatment
$42.65 per 15 minutes
An Initial assessment that requires complete medical history, substance use history and appropriate targeted physical examination.
Guidelines:
- Payable to a maximum of 4 units per patient/per day/per assessment or intended induction
- Payable only to the physician who intends to provide or share management of the patient’s substance use disorder
- Payable only for physician time spent on patient assessment (and on administration of first dose of OAT if provided same day)
- Payable for assessment for change of OAT with discussion of transition to a different OAT medication
- Start and end times required
- No other visit fees billable same day except 13014, 13024, 14018 and 14077. 13014, 13024, 14018 and 14077 payable in addition to this code only when not performed concurrently
2. 13014: Management of OAT Induction for Opioid Use Disorder
$20.21
This fee is payable for individual interactions with the patient during the first 3 days of OAT induction for opioid use disorder.
Guidelines:
- Billable in addition to 13013 detailed above or a same day visit fee (in-person, telephone or video conference) with a physician when not performed concurrently
- Payable up to 3 times on day of first dose of OAT
- Payable up to 2 times on day 2 of OAT induction
- Payable once only on day 3 of OAT induction
- May be provided in-person, by telephone or by video conference
- May be billed when delegated to a nurse (LPN, RN, NP) employed within the eligible physician practice
- Start and end times required
3. 00039: Management of Maintenance Opioid Use Disorder
$23.67
A weekly fee payable to the physician responsible for the continuous management of a patient’s opioid use disorder. Applicable only to patients with a documented diagnosis of opioid use disorder.
Guidelines:
- Payable only to the physician or physicians responsible for the provision of continuous care management of the patient’s opioid use disorder
- Applicable only to patients with a confirmed diagnosis of opioid use disorder, the effects of which are significant enough to require active monitoring and management
- Face-to-face contact with the patient is not necessarily required for this fee to be paid
- This fee is payable once per week per patient regardless of the number of services per week for management of the patient’s opioid use disorder
- First payable after one full week of care, including at least one physician visit service (office, telephone, video, home, facility visits)
- The physician must have at least one visit service (office, telephone, video, home, facility visits) with the patient every 90 days
- Visit services are payable in addition
- Payable weekly as long as the patient requires ongoing management of their opioid use disorder
4. P13023: Management of Substance Use Disorder (SUD)
$25.94
A monthly fee payable to the physician responsible for the continuous management of a patient’s substance use disorder, other than opioid use disorder. Applicable only to patients with a documented diagnosis of substance use disorder
Guidelines:
- Payable only to the physician or physicians responsible for the provision of continuous care/management of the patient’s substance use disorder
- Applicable only to patients with a confirmed diagnosis of substance use disorder, the effects of which are significant enough to require active monitoring and management
- Face-to-face contact with the patient is not necessarily required for this fee to be paid
- First payable after one full month of care, including at least one physician visit service (office, telephone, video, home, facility visits). If the required physician visit was provided by a physician associated with a different payee number, a note record is required with this explanation
- This fee is payable once per month per patient
- The physician must have at least one visit service (office, telephone, video, home, facility visits) with the patient every 90 days
- Visit services are payable in addition
- Payable monthly as long as the patient requires ongoing management of their substance use disorder
- Claim must include ICD-9 code specific to the substance use disorder
5. P13024: Outpatient Management of Alcohol Withdrawal
$25.94
Applicable only to patients with a documented diagnosis of alcohol use disorder.
Guidelines:
- Payable only to the physician or physicians responsible for the provision of outpatient management of alcohol withdrawal
- Payable in addition to 13013 or a same day visit fee (in-person, telephone or video)
- Payable once daily for up to 5 consecutive days, per patient, beginning on the day of the first dose of medication
- May be provided in-person, by telephone, or by video
- May be delegated to a nurse (LPN, RN, NP) employed within the eligible physician practice
6. 15040: GP Point of Care (POC) testing for amphetamines, benzodiazepines, buprenorphine/naloxone, cocaine metabolites, methadone metabolites, opioids and oxycodone
$12.89
Only POC urine testing kits that have met Health Canada Standards are to be used. This fee includes the adulteration test too.
Guidelines:
- Payable only before induction
- It can only be billed if your patient is enrolled in the B. C. Methadone Maintenance Treatment Program.
7. 15039: GP Point of Care testing for opioid agonist treatment
$12.89
Only POC urine testing kits that have met Health Canada Standards are to be used. This fee includes the adulteration test too.
Guidelines:
- Payable only after induction complete
- Maximum 26 per calendar year
- You can only submit a claim for 15039 if you have exemptions to prescribe methadone or buprenorphine/naloxone for your patients with opioid dependency in B.C.
- It can only be billed if your patient is enrolled in the B. C. Methadone Maintenance Treatment Program.
Addiction Medicine Billing Tips:
Tip #1:
Fee Codes 15040 and 15039:
- If you’re doing screening on the patient you can bill a 15039 (if they’re part of the methadone program) or a 15040 (if they’re not part of the program).
- You can bill 15040 if you’re running a test for the first time, and the patient hasn’t been registered in the program yet. After they’re registered bill a 15039 every 2 weeks.
Tip #2:
If billing a visit when your patient is inducted into treatment, make sure you change your patient’s diagnosis. It has to have a completely different and unrelated diagnosis or else MSP will reject it.
Tips #3
When taking over care of a patient on OAT from another physician, make sure to include the date you took over care in the note record, and make sure the old doctor has taken the patient off their billing list.
If you have any questions regarding any of these codes, or addiction medicine in general, please don’t hesitate to contact our BC billing team.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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