SpecialtiesCare settings & programs
How we see substance-use treatment billing.
Reviewed by the VisMed care settings & programs billing team
Treatment programs bill by level of care: detoxification, residential, partial hospitalization, intensive outpatient and outpatient, each with per-diem or bundled rates on some plans and itemized services on others. Admission is authorized for a number of days, and continued stay is reviewed against medical-necessity criteria at intervals the payer sets. Miss a review and the days after it are unpaid.
Medication-assisted treatment adds office-based codes, medication rules and, for opioid treatment programs, weekly bundles. Laboratory testing follows the toxicology rules that payers scrutinize most. And, as in all behavioral health, the license type of the treating clinician decides whether the payer pays at all.
VisMed keeps a per-patient authorization calendar that your clinical team can see, constructs level-of-care claims per plan, applies testing rules per payer at ordering and scrubbing, and keeps a licensure matrix so sessions are scheduled with billable clinicians.
Where substance-use treatment practices lose money
The patterns we find in the aging and denial history before anything else changes.
Continued-stay reviews missed
Days beyond the authorized period, without a completed review, are unpaid. Reviews take clinical time and slip.Level of care billed wrong for the plan
Per-diem, bundled and itemized constructions differ by plan and level. The wrong construction is denied or paid short.Testing outside policy
Frequency and definitive testing rules apply as in any toxicology billing, and programs are audited for them.Clinician licensure
Counselors and other staff have varying recognition across payers. Services by unrecognized staff are unpaid.Out-of-network admissions
Programs admitting out-of-network patients face payer-determined payments, verification-of-benefits errors and patient responsibility disputes.
What we do differently for substance-use treatment
Specialty-matched coders and a denials specialist, working inside your own system.
We share the authorization calendar
Admission authorizations, review dates and criteria visible to your clinical team, with reviews prepared by us ahead of each deadline.We construct claims per plan and level
Per-diem, bundled or itemized rules held per payer and applied at claim build.We apply testing rules per payer
Frequency, presumptive and definitive criteria applied at ordering and scrubbing.We verify benefits and keep the licensure matrix
Benefits verified in detail before admission, and services scheduled with payable clinicians.
What we bill
The procedure and code families your account team already works in.
Substance-use treatment billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed keep continued-stay reviews from being missed?
With an authorization calendar per patient shared with your clinical team, showing the next review date and the criteria the payer applies. VisMed prepares the review ahead of the date so the clinical conversation with the payer happens on time.
Can VisMed bill both per-diem and itemized plans?
VisMed holds each plan’s construction per level of care in our rules and applies it automatically, and compares payments with the expected rate.
How does VisMed handle drug testing in our program?
Under each payer’s policy on frequency and definitive testing, applied at ordering and at claim scrubbing, with documentation of medical necessity, because program testing is among the most audited areas in behavioral health.
Does VisMed do verification of benefits for admissions?
VisMed’s verification covers levels of care, authorization requirements, network status, deductibles and out-of-pocket maximums, so admissions decisions are made with accurate information.
Does VisMed bill opioid treatment program bundles?
Yes. Medicare and many state Medicaid programs pay opioid treatment programs a weekly bundle by medication, with add-ons for intake, counseling beyond the bundle and take-home doses. VisMed builds the weekly claim from the dosing and counseling records so the bundle and the add-ons match what was delivered.
Also in care settings & programs
Federally qualified health centers
PPS rates, wrap-around and sliding-fee reporting.
Durable medical equipment
Orders, proof of delivery and competitive-bid rules.
Wound care
Debridement levels, skin substitutes and frequency edits.
Hospice
Election periods, levels of care and NOE timing.
Home health
OASIS-linked episodes and PDGM grouping.
Nursing homes & assisted living
Consolidated billing and Part B carve-outs.
Behavioral health
Parity rules, telehealth and group-session codes.
All specialties
The full list, in six groups
See where your substance-use treatment practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med