SAMHSA’s 2024 National Survey on Drug Use and Health, released on July 28, 2025, estimated that 48.4 million people aged 12 or older (16.8%) had a substance use disorder in the past year. About 10.2 million of the people classified as needing treatment received it. Each of those episodes produces a claim, and substance abuse insurance billing requirements are less uniform than those for most outpatient specialties. A session can be billed correctly to Medicare and rejected by a state Medicaid plan that wants a different code, a different modifier and a different unit of service.
Substance abuse insurance billing requirements vary by payer and setting. Review the 2026 codes, modifiers, ASAM rules and 42 CFR Part 2 duties for SUD claims.
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