Are you thinking of adding Peer Support Services to your addiction treatment or sober living home? If you operate in New Jersey, Arizona, Washington, or Virginia, read on.
Each of these states offer peer support services to Medicaid patients. Most of these states don’t require co-pays or extensive rules restricting access to services, although some do have details that are worth noting.
Let’s break it down state-by-state.
New Jersey: Peer Support Services are Covered for Sober Living and Addiction Treatment
Yes, New Jersey allows Medicaid patients to access coverage for Peer Support Services in group and individual settings. NJ FamilyCare accepts group peer support services under the CPT code H0036, with modifier HQ52. Individual peer support services are also billed under H0036, with a modifier of “52.” Patients may not be enrolled in other programs, such as ICMS, PACT or community residences in order to receive coverage for peer support services, as that would constitute “double dipping” on this benefit.
If you’re looking for more resources on Behavioral Health and Addiction Treatment business management in New Jersey, check out our other blogs on the The Garden State:
Thinking of Opening an Addiction Treatment Center in New Jersey? Here’s How.
5 Keys to Medicaid Billing for Addiction Treatment in New Jersey
Arizona: Copays May Come Into Play for Medicaid Patients Accessing Peer Support Services
Yes, Arizona covers peer support services under their Medicaid program with some caveats. While individual and group services are covered with no limits or restrictions on access to services, some patients are responsible for copays associated with peer support services. According to KFF, the higher the patient’s income, the more likely they are to cross a threshold which will make them subject to copays.
You can access all of our resources for Arizona addiction treatment business management here:
How to Start a Addiction Treatment Center in Arizona the Easy Way
Medicaid Billing for Addiction Treatment in Arizona
How to Get an Addiction Treatment or Behavioral Health Center Licensed in Your State—Part 1
Washington State: Good Coverage for Peer Support Services in Addiction Treatment Programs and Sober Living Homes
According to the Washington State Health Authority’s handy PDF guide to peer support services, the Evergreen State has been providing peer support services to addiction treatment patients accessing Medicaid since 2019. Since the state was one of the first locations to offer peer support services to Medicaid patients, it shouldn’t be surprising that Washington maintains robust coverage for peer support services. In the Evergreen State, there are no copays and no restrictions on peer support services for Medicaid patients. There are over 6000 licensed and trained peer support service providers in Washington.
For more helpful hints on managing an addiction treatment center in Washington, see:
Secrets of Medicaid Billing for Addiction Treatment in Washington
Thinking of Opening an Addiction Treatment Center in Washington? Here’s What You Need to Know.
Virginia: This State Has a Few Important Rules Governing Peer Support Services
Virginia does cover peer support services without a copay for Medicaid or Cardinal Care patients. However, in order to access services, patients must be registered with the Medicaid system.
Virginia’s Peer Recovery Support Service Supplement Manual offers a few more details on some of the limitations that do apply, however. For example, patients may not receive more than 4 hours of peer support services per day, and no more than 900 total hours. Group peer support services cannot contain groups larger than 10 patients. Furthermore, there are strict rules about what counts as billable hours for peer support service providers when it comes to Medicaid billing in Virginia. For example, you can’t compile progress notes, do case management, help with practical matters like transportation, chores, or grocery shopping while providing peer support services in Virginia.
For more help with Medicaid billing in Virginia, see our posts:
How to Optimize Addiction Treatment Billing for Virginia Medicaid
It’s a Good Time to Open an Addiction Treatment Center in Virginia
What CPT Codes are Used for Peer Support Services in New Jersey, Arizona, Washington, and Virginia?
Technically speaking, each state can require a different - or slightly different - CPT code for Peer Support Services. That said, the most common CPT code for Peer Support Services is H0038. Many states require specific modifiers to distinguish group, individual, and family Peer Support Service sessions from one another.
Sober Living App Helps Sober Living Succeed
Sober Living App makes it easier - and more profitable - to operate sober living homes.
Our all-in-one app handles rent collection, admissions, property management, residents’ care coordination, community contacts, transportation details, calendars, staff, alumni and more - all from the convenience of your phone.
Claim your free trial today and see why more sober living homes prefer the Sober Living App.