Detox and Residential Treatment Billing That Protects Every Authorized Day
A single residential day can be worth more than a week of outpatient care, and a single missed concurrent review can cost the rest of the stay. We bill detox and residential programs as the facilities they are: per diem claims on the UB-04, coded to the level of care, backed by documentation that satisfies the payer's reviewer, and tracked day by day against every authorization.
Since 2014
Billing Nevada practices
Concurrent review
tracking on every admission
42 CFR Part 2
trained
No setup fee
60-day exit
What Detox and Residential Billing
Requires That Outpatient Billing Doesn't
Detox and residential billing is facility billing for 24-hour substance use disorder care, from withdrawal management through clinically managed residential treatment. Claims are usually billed per day, on an institutional UB-04, with revenue and HCPCS codes that must match the level of care the payer authorized.
The clinical work is round-the-clock, and so is the billing risk. Every day must be authorized, every level change documented, and every claim built to the contract, since one payer pays a bundled per diem and another wants room and board, treatment, and physician services on separate lines.
Why Detox and Residential Claims Get Denied,
and Which Denials Can Be Prevented
Authorized days run out unnoticed.
Payers approve a few days at a time. Without a review requested in time, the extra days aren't paid.
Level of care doesn't match the record.
A claim billed as acute withdrawal management, with notes describing sub-acute symptoms, invites denial or a downgrade.
Wrong claim structure for the contract.
Revenue codes, HCPCS codes, and per diem bundling vary by payer, and a mismatch sends the claim back.
Room and board billed where it's excluded,
or left off where it's payable.
Licensure or accreditation gaps.
The payer's records must show the facility licensed and credentialed for the level billed.
Out-of-network stays without an agreement.
Treating before a single case agreement is signed leaves the rate open to whatever the payer decides.
Find out how many authorized days you're losing.
Detox Billing Coded to the Level
of Care Your Records Prove
Payers decide medical necessity using the ASAM Criteria, or their own criteria based on it. The level billed must match the patient's assessment, the documented withdrawal severity, and the authorization. These are the codes most commonly used for each setting. Your contracts decide which apply.
| Service | Common HCPCS codes | Common revenue codes | Billing note |
|---|---|---|---|
| Sub-acute residential detox | H0010 | Detox room-and-board series (0116–0156) | Billed per day; documentation must show withdrawal managed without acute medical monitoring |
| Acute residential detox | H0011 | Detox room-and-board series (0116–0156) | Requires documented medical monitoring; the most frequently downgraded level |
| Ambulatory detox | H0014 | Per contract | Outpatient withdrawal management, billed per visit or day |
| Short-term residential treatment | H0018 | 1002 (residential, chemical dependency) | Per diem, usually without room and board |
| Long-term residential treatment | H0019 | 1002 | Per diem for longer, non-acute stays |
| Bundled program per diem | H2036 | Per contract | Used by some payers for an all-inclusive daily rate |
| Physician and NP services | CPT E/M and psychiatric codes | Billed on the CMS-1500 | Often billed separately from the facility per diem |
Some payers want one bundled per diem line, and others want separate lines for room and board, treatment, and professional services. We build each claim to the contract, not to a template.
Authorizations and Concurrent Reviews,
Tracked Day by Day
Most residential and detox stays are authorized in blocks of days. Before each block ends, the facility must send updated clinical information for a concurrent review, or the next days go unpaid. We:
- Secure pre-admission authorization, and confirm the exact level and number of days approved.
- Alert your utilization review team before every authorization ends.
- Package clinical updates against the payer's criteria, for each review.
- Prepare peer-to-peer reviews and expedited appeals when days are denied.
- Transfer authorization smoothly at each step down, to PHP, IOP, or outpatient care.
Parity Protections, Used When Payers Overreach
The Mental Health Parity and Addiction Equity Act requires most health plans to cover substance use disorder treatment on terms no more restrictive than medical and surgical care. When a plan applies stricter limits to residential treatment than it applies to comparable medical stays, such as skilled nursing or inpatient rehabilitation, we raise parity in the appeal.
Out-of-Network Stays, Settled Before Admission
Many treatment programs are out of network with some of their patients' plans. Before an out-of-network admission, we verify OON benefits and deductibles, and negotiate a single case agreement where the plan allows it, so the rate is agreed in writing before the first day is billed. See out-of-network billing.
Payers Behind Nevada Treatment Programs
We bill commercial health plans, employer self-funded plans, Nevada Medicaid and its managed care plans, and TRICARE, plus out-of-network plans through single case agreements. Coverage for residential and detox levels differs by plan and changes often, so we verify every admission against current rules. Your facility's state licensure, and any Joint Commission or CARF accreditation, must be on file with each payer for the levels you bill.
SUD Records Handled Under 42 CFR Part 2
Records from federally assisted substance use disorder programs carry federal confidentiality protections beyond HIPAA. Our team handles them under 42 CFR Part 2 and our HIPAA compliance program, sharing only what each claim or review requires.
Detox and Residential Billing Services,
from Admission to Final Payment
Verification of benefits
Before admission, we confirm residential and detox coverage, day limits, deductibles, out-of-pocket maximums, out-of-network benefits, and room-and-board terms.
Pre-admission authorization
We secure approval for the right level of care and number of days, and record the reference number, reviewer, and next review date.
Concurrent review management
We track every authorization end date, alert your UR team in time, and keep each review's clinical information complete.
Facility coding and claim building
We assign revenue and HCPCS codes to match the authorized level, apply each contract's per diem rules, and submit UB-04 claims on time.
Professional billing
We bill physician, nurse practitioner, and psychiatric services provided during the stay on the CMS-1500, where the contract allows them separately.
Single case agreements
We negotiate out-of-network rates before admission and get them in writing.
Denials and level-of-care appeals
We prepare peer-to-peer reviews, first- and second-level appeals, parity arguments, and external reviews, with the clinical record behind each.
Payment posting and underpayment recovery.
We post every payment, compare it with the contracted or agreed per diem, and pursue shortfalls.
Patient responsibility.
We send clear statements for deductibles and coinsurance, and set up payment plans that match your financial policy.
Reporting.
Each month, you get days authorized vs. billed vs. paid, denials by reason and payer, and AR by level of care.
From Admission Call to Paid Claim:
Our 6-Step Facility Billing Process
- 1
Verify.
Confirm benefits, level-of-care coverage, and network status before admission.
- 2
Authorize.
Secure pre-admission approval, or a single case agreement for out-of-network stays.
- 3
Track.
Monitor every authorized day, and trigger concurrent reviews before coverage ends.
- 4
Bill.
Build UB-04 and CMS-1500 claims to each payer's contract, and submit on time.
- 5
Defend.
Appeal denials and downgrades with clinical evidence, and parity where it applies.
- 6
Collect.
Post payments, recover underpayments, and report results by level of care.
See where your facility's days and dollars are slipping.
One Billing Team Across
the Full Continuum of Care
Patients rarely stay at one level. We bill each transition without a gap in authorization: detox to residential, then PHP and IOP, outpatient care, and MAT. See our substance abuse billing overview for the full program.
Built for Nevada Detox
and Residential Programs
- Standalone detox and withdrawal management centers
- Residential treatment centers (RTCs) for substance use disorders
- Dual-diagnosis programs treating SUD with co-occurring mental health conditions
- Integrated programs offering detox, residential, PHP, and IOP under one roof
- New facilities preparing to bill their first admissions
Opening a new program? Our medical credentialing team handles payer enrollment and contracting before your first admission.
Facility Pricing Built Around Your Census
Detox and residential programs are billed on our Enterprise plan, priced from 4.0% of net collections according to census, payer mix, and level-of-care mix. There's no setup fee, and you can leave with 60 days' notice. Older facility AR can be recovered on contingency.
Commitments
We Put in Writing
Every authorization tracked, with a review alert before each approved block of days ends.
UB-04 claims submitted within 24 hours of receiving complete documentation.
Every denial and downgrade worked within 5 business days, with peer-to-peer support where it's offered.
No out-of-network admission billed without verified benefits, or a signed single case agreement where available.
A named account manager who knows your levels of care and your payers.
BAA signed, and 42 CFR Part 2 handling, before we see any patient data.
Detox and Residential Billing
Questions Treatment Programs Ask Us
Can't find what you need? Our Nevada team answers every question before you commit.
They cover verification of benefits, pre-admission authorization, concurrent review tracking, UB-04 coding to the level of care, professional billing, single case agreements, denials and appeals, payment posting, and reporting.
The facility's per diem is usually billed on a UB-04. Physician and nurse practitioner services are often billed separately on a CMS-1500. Each contract decides the exact structure.
H0010 describes sub-acute detoxification in a residential setting; H0011 describes acute detoxification needing closer medical monitoring. Billing H0011 requires documentation of that higher acuity, or the payer will downgrade or deny the claim.
The days after the authorization ends usually go unpaid. We track every end date and alert your team before reviews are due.
Often, through a single case agreement or the plan's out-of-network benefits. We verify both before admission, so the rate is agreed in writing.
Where the contract or plan pays for it. Some payers include it in the per diem, some pay it separately, and some exclude it entirely. We confirm which before billing.
We share SUD records only as Part 2 and HIPAA permit, and only what each claim or review requires. Staff working on SUD accounts are trained on these rules.
We work inside your current EHR and billing system. Tell us which one you use, and we'll confirm the workflow during your free review.
Keep exploring
Every Authorized Day Should Become a Paid Day.
Send us 90 days of claims and authorization data. We'll show you where reviews were missed, which levels of care were downgraded, and what's recoverable. You get a written review within 5 business days, at no cost.
Please don't include patient information. We sign a BAA and follow 42 CFR Part 2 before reviewing any data.