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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.

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Medical billing modifiers provide additional information about a healthcare service without changing the basic procedure code. In behavioral health billing, modifier HM indicates that the service was provided by a professional whose qualification level is below a bachelor's degree. Its use can affect how Medicaid programs and other payers process claims, identify service providers, and determine reimbursement.

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Discover Daphne Alexander – Talent, Creativity, and Screen Presence

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