SUD Billing by ASAM Level of Care: H-Codes and Documentation

ASAM sets the clinical level of care. The payer's crosswalk sets the code, the unit and the claim form. Start with the level and then open that payer's manual.

The adult 4th edition keeps four broad levels and splits each one into numbered steps. The decimal tells you two things: how many hours of clinical services the program gives each week and who leads treatment planning. At the x.1 and x.5 levels clinical staff lead it. At the x.7 levels medical staff lead it and the focus shifts toward withdrawal management and biomedical care (ASAM Criteria 4th edition adult overview).

Sources: ASAM adult overview for names and hours, ASAM Criteria FAQ for withdrawal management and Optum's July 2025 notice for the old 2.5 name. The chart also has co-occurring enhanced versions and a 3.7 BIO program.

Notice what the table leaves out: a code. Codes and claim forms come from each payer. Levels 2.1 and 2.5 follow their own revenue code and per diem HCPCS rules, covered in our IOP and PHP billing codes guide.

The 4th edition renumbered parts of the continuum and folded withdrawal management into the main levels. Payers adopt it on their own schedule, so the edition in your contract decides which level names go on the authorization.

ASAM released the adult 4th edition in digital form in October 2023 and in print in December 2023 (ASAM Criteria FAQ).

Level changes that affect billing

Three changes touch claims and authorizations:

• Level 1.0 is new. It covers long-term remission monitoring (ASAM overview). Watch the number. Some payers still use "1.0" for their 3rd edition outpatient level, as Virginia does for example (see the Level 1 section below).
• Withdrawal management is no longer separate. 1-WM became 1.7 and 2-WM became Level 2.7 Medically Managed Intensive Outpatient. 3.2-WM moved into 3.5 and 3.7-WM moved into 3.7 (ASAM Criteria FAQ).
• Level 3.3 is off the adult chart (ASAM overview).

Dimension changes

The six dimensions were renamed and reordered. In the 4th edition they are Intoxication, Withdrawal, and Addiction Medications; Biomedical Conditions; Psychiatric and Cognitive Conditions; Substance Use-Related Risks; Recovery Environment Interactions; and Person-Centered Considerations. Readiness to change is no longer its own dimension. It's now weighed inside the others and Dimension 6 is new (ASAM overview).

So an assessment form built on 3rd edition dimension names may not line up with a 4th edition payer's review.

Who uses which edition

ASAM says it isn't a regulatory body. States and payers decide if and when they adopt the 4th edition (ASAM Criteria FAQ). Here's what four example payer documents say today:

So one program can bill a 4th edition Level 2.7 to one payer and a 3rd edition 2-WM service to another in the same week. Check which edition your payer contract uses before you write the level on an authorization request.

Adolescents

ASAM says its adolescent and transition-aged youth volume is now available (ASAM Criteria FAQ). Payer adoption is a separate question. Optum's July 2025 notice covers adult commercial members. Providers with a 3rd edition National Gold Card exemption can keep using it for adolescent members ages 12 to 17 (Optum July 2025 notice). For adolescent programs ask each payer which edition applies.

HCPCS codes name a type of service, not an ASAM level. So states and plans write their own crosswalks. A code that's right in one state can be wrong in the next.

The CMS descriptors show the gap. H0010 is sub-acute detox in a residential addiction program (inpatient). H0011 is acute detox in the same setting. H0012 and H0013 are sub-acute and acute detox in a residential program (outpatient). H0014 is ambulatory detox. H0018 is short-term residential without room and board, per diem. H0019 is long-term residential (typically over 30 days) without room and board, per diem. H2034 is halfway house services, per diem. H2036 is an alcohol and/or other drug treatment program, per diem (CMS HCPCS quarterly update, October 2026 file). None of them names a level.

Here's how three Medicaid programs fill that gap. These are examples, not a crosswalk to copy.

Sources: Virginia ARTS Reimbursement Structure, last updated Oct 4, 2023 and ARTS Manual ch. V, rev. Nov 6, 2025; Ohio BH Manual v1.28.1, §5 Tables 5-1 to 5-6; Washington SUD Billing Guide, residential and withdrawal management tables. Levels 2.1 and 2.5 are left out on purpose.

Look at H2036. Virginia uses it for Level 3.7. Ohio uses it for 3.5 and adds a modifier for 3.3 and 3.7. Washington uses it for room and board. H0010 is Level 3.3 and 3.5 in Virginia but 3.2-WM in Ohio and Washington. H0011 is Level 4.0 in Virginia but 3.7-WM in the other two. A biller who learned the codes in one state can miscode residential claims in the next.

What this means for billing

Keep one crosswalk per payer. Each row runs level, code, modifier, unit, claim form and authorization rule. Recheck it when the payer posts a new manual or moves to a new edition. Keeping one current for every payer is part of behavioral health revenue cycle management and not a one-time setup.

Level 1 is mostly billed on professional claims with assessment, counseling and treatment planning codes. Medicare-enrolled opioid treatment programs bill weekly bundles instead.

HCPCS has a set of alcohol and drug codes that some payers use for outpatient care. H0001 is an alcohol and/or drug assessment. H0004 is behavioral health counseling per 15 minutes. H0005 is group counseling by a clinician. T1006 is family or couple counseling. T1007 is treatment plan development or modification. H0050 is a brief intervention per 15 minutes (CMS HCPCS October 2026 file). Payer acceptance varies, so check the manual before you build charge codes around them.

Authorization rules vary too. For example Virginia Medicaid requires no service authorization for its Level 1.0 outpatient services or for opioid treatment programs (OTPs) and office-based addiction treatment (OBAT) (ARTS Manual ch. IV). Remember Virginia uses the 3rd edition. Its "1.0" is outpatient services and not the 4th edition's remission monitoring level. The same chapter lists OTP and OBAT without an ASAM level number.

Medicare OTP bundles

Medicare pays enrolled OTPs through weekly bundles. Each bundle covers dispensing or administration, counseling, therapy and toxicology testing if performed. The bundle code depends on the medication (CMS HCPCS October 2026 file):

• G2067 methadone
• G2068 oral buprenorphine
• G0533 weekly injectable buprenorphine
• G2069 monthly injectable buprenorphine
• G2073 naltrexone
• G2074 a week without the drug
• G2075 a medication not otherwise specified

Add-on codes sit on top. G2076 covers intake. G2077 covers periodic assessment. G2080 covers each extra 30 minutes of counseling in the week. G2078 and G2079 cover take-home supplies of methadone and oral buprenorphine. G0137 covers OTP intensive outpatient services, which CMS says not to bill unless the patient got at least 9 IOP services in the week (CMS OTP Billing and Payment).

Three billing rules from the same CMS page:

• Don't bill a weekly bundle for the same patient more than once in a 7-day period. Modifier 59 covers limited cases such as syncing a new patient to the billing week or a holiday closure.
• Professional claims go on the CMS-1500 with place of service 58.
• Institutional claims go on the CMS-1450 with revenue codes 090x to 091x or 0949.

The revised 42 CFR Part 8 rule for OTPs was published on February 2, 2024 (SAMHSA statutes, regulations and guidelines). It updates OTP accreditation, certification and treatment standards, which sit apart from billing.

Level 2 now covers 2.1, 2.5 and 2.7, which took over from 2-WM. Code choice for 2.1 and 2.5 follows the IOP and PHP rules. Level 2.7 is where some payers moved the medical services.

Level 2.1 gives 9 to 19 clinical hours a week. Level 2.5 gives 20 or more. Level 2.7 is medically managed and includes withdrawal management (ASAM overview). Under the 3rd edition 2.5 was partial hospitalization, and that rename is where billing shifts.

Optum's 4th edition contract change

Optum's July 2025 notice is one example of how a payer moved its codes for adult commercial members (Optum July 2025 notice):

• SUD partial hospitalization at 3rd edition Level 2.5 used revenue code 912 or 913.
• Under the 4th edition, High-Intensity Outpatient 2.5 uses revenue code 907.
• Medical treatment for withdrawal and for biomedical and psychiatric conditions moves to Medically Managed Intensive Outpatient 2.7. That uses revenue code 944 or 945 with the medical services billed on their own.
• Names and revenue codes for 2.1 and 3.5 didn't change.
• Until a facility has a fully executed updated contract it keeps following the 3rd edition for adult commercial PHP.

The notice also says the old programs and revenue codes no longer exist under the 4th edition, which ended Gold Card exemptions for those adult services. If you run a PHP track for Optum members, find out which contract you're on before the next claim goes out.

Running IOP and high-intensity tracks under two editions at once is easy to get wrong. Our IOP and PHP billing team checks attendance, notes and the authorization before each day goes out.

Residential and inpatient levels pay a facility per diem. What the per diem includes decides what else you can bill.

What the per diem covers

For example Virginia's residential per diem for Levels 3.1 to 3.7 includes treatment planning, care coordination, skills restoration and crisis response. Room and board and daily supervision are inside it at 3.3, 3.5 and 3.7 but can be paid separately at 3.1. Physician services, other professional services such as psychotherapy, pharmacy, lab and several others can be billed separately (ARTS Manual ch. V).

Ohio is a second example. It needs at least one documented face-to-face service from the treatment team to bill a residential per diem, and the per diem doesn't include room and board. Psychotherapy, counseling and SUD assessment can't be billed the same day as the residential per diem. The exception is medically necessary services from practitioners who aren't affiliated with the program (Ohio BH Manual v1.28.1, §5).

Withdrawal management

The CMS descriptors for H0010 to H0014 split detox by acuity and setting, as shown above. States then attach those codes to their own levels. Two examples:

• Ohio: ASAM 2 WM bills as H0012 per diem or H0014 hourly. The two aren't allowed on the same date of service (Ohio BH Manual, Table 4-9). 3.2 WM bills as H0010 and 3.7 WM as H0011 (Tables 5-2 and 5-6).
• Washington: 3.2-WM bills as H0010 and 3.7-WM as H0011. Neither needs prior authorization and length of stay is based on medical necessity (WA SUD Billing Guide).

Under the 4th edition, 3.2-WM services sit inside Level 3.5 and 3.7-WM sits inside 3.7 (ASAM Criteria FAQ). A payer that has moved to the 4th edition may not accept a separate WM line at all. Ask.

Level 4

For example Virginia bills Level 4.0 as H0011 with revenue code 1002. Psychiatric units and freestanding psychiatric hospitals get an all-inclusive per diem. Acute care hospitals are paid by DRG (Virginia ARTS Reimbursement Structure; ARTS Manual ch. V).

Claim form by level

Claim forms differ too. For example Virginia's recommended billing method puts Level 3.1 on the CMS-1500 and Levels 3.3, 3.5, 3.7 and 4.0 on the UB (ARTS Manual ch. V). Washington bills its withdrawal management levels on the 837P professional claim (WA SUD Billing Guide).

Payers approve an ASAM level when the assessment shows why that level and not a lower one. They keep approving it only when reassessments show the patient still meets it.

The assessment

Under the 4th edition, Dimensions 1 to 5 drive the level of care recommendation. Dimension 6 is where the assessor works out with the patient which level they're willing and able to take part in (ASAM overview). Payers check that logic. For example Virginia Medicaid says authorization requests must include a current multidimensional assessment that addresses all six dimensions. Requests that don't meet the ASAM requirements for the level won't be approved (ARTS Manual ch. IV).

Which levels need authorization

Two examples:

• Virginia: service authorization is required for Levels 2.1 through 4.0 and not for Level 1.0, OTP or OBAT (ARTS Manual ch. IV).
• Ohio: SUD residential (H2034, H2036) runs up to 30 consecutive days without prior authorization for the first two stays in a calendar year. After 30 days prior authorization must support the continued stay. Third and later stays in the same year need prior authorization from day one (Ohio BH Manual v1.28.1, Table 1-5).

Independent review for residential

Two state examples: Virginia says CMS requires an independent third party to review all residential requests (ARTS Manual ch. IV). Washington says that under its approved 1115 waiver residential providers must make sure Medicaid clients have an independent assessment from an outpatient provider (WA SUD Billing Guide). Build that step into your intake process.

Reassessment and continued stay

The 4th edition sets reassessment frequency level by level. ASAM gives monthly formal reassessment at Levels 2.1, 2.5, 3.1 and 3.5 as an example and notes that state rules also apply (ASAM Criteria FAQ). At each review the transition and continued service criteria decide whether the patient stays, steps down or steps up (The ASAM Criteria). Put every reassessment date in the calendar the day the authorization is logged.

Part 2 and payers

The 2024 Part 2 final rule changed how SUD records reach payers. Compliance with that rule was required by February 16, 2026. A patient can sign one consent for all future treatment, payment and health care operations disclosures. HIPAA covered entities and business associates that receive records under it can redisclose them under HIPAA, but the records can't be used in legal proceedings against the patient without specific consent or a court order. SUD counseling notes need their own separate consent (HHS Fact Sheet: 42 CFR Part 2 Final Rule). Each disclosure made with consent must carry a written Part 2 notice and a copy of the consent or a clear explanation of its scope (42 CFR 2.32). This is a summary and not legal advice.

Documentation ties all of this together. Our substance use disorder billing team reviews documentation against ASAM standards before authorization requests go out.

• The ASAM edition named in each payer contract is on file
• Level names on each authorization match that edition
• One crosswalk per payer: level, code, modifier, unit and claim form
• Room and board treatment checked for each payer
• A six-dimension assessment is on file for each admission
• Independent assessment or review done where the state requires it
• Reassessment dates in the calendar
• Same-day billing limits checked for residential and withdrawal management
• Medicare OTP bundles billed once per 7-day period
• Part 2 consent on file before records go to a payer

Not sure whether level and code mismatches are already costing you paid days? Start with a free revenue audit.

Payer, state and edition rules vary and change. Confirm the details with each payer's current manual and your contract. This isn't legal or coding advice.