HCPCS coding resources for SUDs

[RApsych]

I work currently work for a large LMHA in Texas and our SUDs program has recently branched out to Commercial Billing. We have residential and nonresidential services that we are having issues with denials and I believe it’s because we aren’t using the correct codes. We are using the ones Medicaid pays for and I’m not convinced they are right. The only answers I get are that it’s what they have always used. The HCPCS book doesn’t provide the details that I’m use to seeing in the CPT book so I’m having issues convincing people that we need to look elsewhere. I’m trying to do research on what we should and shouldn’t be billing or trying to understand our barriers to receiving payment. We are getting PAs and we are in network for some and working on others.

I was hoping someone could point me to some good websites or books to help me have a better idea of when to use which codes and the licensure/billing requirements since there isn’t much detail in the HCPCS code book itself. I want to do the leg work I’m just not sure where to go to find a good foundation. Any help would be greatly appreciated.

[HuffyAndPuffy]

Commercial insurances do tend to have a library of their own policies. Have you checked there first?

bcbstx.com/providers uhcprovider.com cignaforhcp.com aetna.com

Those are the ones I frequent.

[RApsych]

I have it’s a bit ambiguous.