Addiction Medicine Charge Assembly Software

Charge Assembly in a Addiction Medicine Practice

Charge assembly here is mostly counting. An OTP week can hold daily dosing, two counseling sessions, a group and a urine test, yet Medicare pays one weekly bundle for all of it. The bundle that applies depends on the drug, and a week with no drug uses the non-drug bundle. Extra counseling well past the plan may add an add-on. Office-based treatment works by the calendar month: minutes from planning, care coordination and therapy add up until they reach the threshold for the monthly code. Some Medicaid programs bill counseling with H0004 in 15-minute units. A long-acting buprenorphine injection is coded by product and dose. Definitive drug tests are coded by how many drug classes were tested that day. Addiction medicine charge assembly software pulls each service, time and drug from the documentation, applies the counting rule for the payer, and builds the line with codes, units and modifiers ready for review.

Why Is Charge Assembly Different in Addiction Medicine?

The unit of billing is rarely the visit. For an OTP it is the week, for office-based care the calendar month, and for Medicaid counseling a block of minutes. A charge built visit by visit, the way most practices work, will be wrong in every one of those models. The assembly step has to gather services across the right span before it creates a line.

Thresholds decide whether a charge exists at all. A weekly bundle needs at least one service in the week. OTP intensive outpatient needs at least nine qualifying services, and services already used for other bundles or add-ons don't count. Office-based codes need a minimum number of minutes in the month. If the count falls short, there is nothing to bill, and staff need to know that before the period closes.

Drugs and tests are coded by detail. Brixadi has separate codes for its weekly and monthly doses, and Sublocade's codes split at 100 mg. Definitive tests are coded by the number of drug classes. The dose given and the panel run have to come straight from the record, or the line is wrong from the start.

What Addiction Medicine Charge Assembly Software Handles

Non-drug weekly bundle (G2074)

CMS says that if no drug was given during the week, the OTP must bill G2074, and the week needs at least one non-drug service. Assembly checks the week's dosing log before choosing the bundle. (Medicare Claims Processing Manual, Chapter 39: Opioid Treatment Programs (Rev. 13572, 2026))

Extra counseling add-on (G2080)

G2080 adds each additional 30 minutes of counseling or therapy in a week when services substantially exceed the patient's treatment plan. Assembly compares logged counseling time with the plan, and the clinician documents why more was needed. (Medicare Claims Processing Manual, Chapter 39: Opioid Treatment Programs (Rev. 13572, 2026))

OTP intensive outpatient threshold (G0137)

G0137 needs at least nine OTP intensive outpatient services in the week. Medication and toxicology testing don't count, nor do services already used for another bundle or add-on, so assembly counts only what qualifies. (Medicare Claims Processing Manual, Chapter 39: Opioid Treatment Programs (Rev. 13572, 2026))

Office-based monthly minutes (G2086, G2087, G2088)

For Medicare, G2086 needs at least 70 minutes in the first month and G2087 at least 60 minutes in later months, with G2088 for time beyond 120 minutes. Assembly totals the month's minutes before creating the line. (CMS: Office-Based Substance Use Disorder (SUD) Treatment Billing)

Long-acting buprenorphine codes (J0577, J0578, Q9991, Q9992)

Brixadi is coded J0577 for the weekly dose and J0578 for the monthly dose. Sublocade is coded Q9991 for doses up to 100 mg and Q9992 above 100 mg. Assembly picks the code from the product and dose given. (UnitedHealthcare Commercial Medical Benefit Drug Policy: Buprenorphine (Brixadi and Sublocade), effective October 1, 2026 (HCPCS code list))

Definitive drug tests by class count (G0480 to G0483)

Definitive codes are reported per day by the number of drug classes tested, from G0480 for one to seven classes to G0483 for 22 or more. Assembly counts classes from the lab result, not from the order. (CMS Transmittal R3439CP (CR 9502): HCPCS codes subject to CLIA edits, including G0480 to G0483)

Counseling units (H0004)

Washington Apple Health bills H0004 individual therapy per 15 minutes, with the HF modifier. Assembly converts documented minutes into units by the payer's rule. Other states may count units differently. (Washington Apple Health (Medicaid) Substance Use Disorder Billing Guide, October 2025)

How Does Addiction Medicine Charge Assembly Software Work?

1. 1. Collect services by period

   Each service is tied to the patient's episode and to the week or month it falls in. Dosing, counseling, groups, testing and visits are pulled from the record as they are documented.

2. 2. Apply the counting rule

   For each payer, the right span and threshold apply: the OTP week, the office-based month or the Medicaid unit. Periods that fall short are shown before they close.

3. 3. Code drugs and tests from the record

   Injection codes come from the product and dose given, and test codes from the lab result. Billing units are figured from the same data.

4. 4. Build lines with modifiers

   Each line gets its codes, units, place of service and any modifier, such as 95 or 93 for counseling by video or phone. Lines then pass to addiction medicine charge validation for payer edits.

5. 5. Release to billing

   Validated lines move to claim building and submission. Anything held is listed with the reason, so staff can close the gap before the period ends.

Addiction Medicine Charge Assembly Software vs. Generic Software

Who Uses It in a Addiction Medicine Practice

• Billing coordinator: Weekly and monthly totals ready to review, with short periods flagged before they close.
• Counselor: Logged minutes that turn into the right units without a separate time sheet.
• Medical director: Confidence that injections and drug tests are coded from what was actually given and run, and that the patient record supports every line.