Substance Abuse Billing Services
Master the ASAM 4th Edition. Optimize MAT Revenue. Eliminate Level of Care Denials.
The mandatory ASAM 4th Edition transition and intensified MHPAEA parity enforcement have changed how payers evaluate “Level of Care.” We ensure precise coding and “Golden Thread” documentation.
ASAM Transition
Navigating the ASAM 4th Edition
The industry has moved beyond 2013 standards. ASAM Level Coding is the foundation of your contract with payers. We’ve restructured billing to align with every major change.
First-Pass Acceptance Rate
vs. 79% industry avg
LOC Denial Rate
vs. 14% industry avg
MAT Accuracy
Across OUD bundles
Days in A/R
vs. 55 days avg
Core Services
SUD & MAT Billing Solutions
Integrated Withdrawal Management
Detox billing restructured to align with the elimination of separate “WM” designations, mapped into the main continuum.
MAT Bundle Automation
Automated capture of G2086 (initial 70-min) and G2087 (subsequent 60-min) bundles for OUD treatment.
Level 1.5 vs. 1.0 Mapping
Documentation supporting higher-intensity Level 1.5 Outpatient Therapy, reserving Level 1.0 for remission monitoring.
PHP/IOP Billing
High-acuity billing for early-stage recovery — securing Length of Stay and managing concurrent reviews with zero gaps.
Clinical Hour Compliance
We audit logs for Level 3.1 Residential to ensure 9–19 documented clinical hours per week, protecting your per diem.
"Golden Thread" Audit Protection
Unbroken documentation chain from diagnosis through treatment plan to progress notes — TPE and RAC ready.
Measurable Results
The Impact: Revix MD vs The Alabama Average
We utilize the Mental Health Parity Act as a primary tool for revenue recovery. When payers issue arbitrary LOC downgrades, we identify parity violations to overturn wrongful denials.
Parity-Driven Appeals
We challenge NQTLs that unfairly restrict SUD benefits compared to medical/surgical benefits.
State Medicaid Waiver Support
Specialized billing for 1115 SUD waivers and block grant funding with unique per diem requirements.
Testimonials
What Our Partners Say
“Revix MD’s ASAM 4th Edition transition was flawless. They restructured detox billing, resulting in 20% more clean claims and zero LOC denials.”
Sarah J.
Executive Director, Heritage Recovery
“Managing MAT G-codes used to be a nightmare. Their automated bundle tracking ensured we never missed a billable minute.”
Mark T.
CFO, Unity Addiction Services
“Their ‘Golden Thread’ audit saved us during a TPE review. We passed with 100% accuracy.”
Dr. Elena R.
Medical Director, Blue Ridge Treatment
Rate Increases Only Matter if Your Claims Get Paid
Revix MD ensures every claim is captured, scrubbed, and paid. We turn potential revenue into actual cash flow.
How do you handle MHPAEA parity violations?
When a payer issues a denial based on “medical necessity” that appears more restrictive than medical/surgical standards, we file parity-based appeals. We require payers to disclose their NQTL analysis, often forcing a reversal of the denial.
Can MAT services be supervised virtually in 2026?
Yes. Under the 2026 Medicare Physician Fee Schedule, “Direct Supervision” includes virtual presence through real-time audio/video technology. However, audio-only is currently excluded for these specific OUD services.
How does the 2026 conversion factor affect our rates?
The 2026 APM conversion factor is $33.57. While this provides a baseline, we focus on margin expansion through 97.4% clean claim rates and aggressive capture of MAT add-on codes.
Do you manage state Medicaid waiver billing for SUD?
Yes. We have specialized expertise in 1115 SUD waivers, managing the complex encounter-rate and per-diem requirements that vary by state.
What happens to my AR if I decide to close my practice?
We offer specialised “Run-out” billing services to ensure all outstanding AR is collected and reconciled, even after your clinical operations have ceased.
What credentials do your addiction billing specialists hold?
Our team consists of CMRS and CPC-certified coders with specific sub-specialties in behavioral health and ASAM 4th Edition criteria.
How do you handle concurrent authorization reviews?
Our UM specialists work daily with your clinical team to pull documentation for concurrent reviews. We ensure that the “intensity of care” documented in the EMR is what is communicated to the payer to prevent premature discharges.