Question 1

What are the new APCM codes for Substance Use Disorders?

Accepted Answer

Starting in 2026, the G0568, G0569, and G0570 codes represent the new APCM framework. For SUD practices, these codes allow for the billing of bundled chronic care services, including MAT monitoring and BHI add-ons, specifically designed for Medicare patients requiring ongoing management of opioid or alcohol use disorders.

Question 2

Can APCM be billed alongside MAT services?

Accepted Answer

Yes, APCM codes can be billed in conjunction with Medication-Assisted Treatment (MAT) services, provided the documentation reflects the management of the patient's chronic condition beyond the basic administration of medication. This often includes coordination of care for co-occurring mental health issues and social determinants of health.

Question 3

What are the time requirements for billing G0568?

Accepted Answer

G0568 generally requires at least 20 minutes of clinical staff time per calendar month spent on care coordination and management. AI-powered call centers can help log this time by automating outreach, screening for relapse triggers, and documenting patient responses directly into the EHR.

Question 4

How does the BHI add-on work for SUD patients?

Accepted Answer

The Behavioral Health Integration (BHI) add-on codes (G0570) provide additional reimbursement when APCM services include specific mental health monitoring. Since SUD patients have high rates of co-occurring depression and anxiety, these codes allow practices to capture the true complexity of the care they provide.

Question 5

What documentation is required for APCM reimbursement?

Accepted Answer

Practices must maintain a comprehensive care plan, document patient consent (including 42 CFR Part 2 requirements), and log all non-face-to-face interactions. Automated systems ensure that every check-in, naloxone coordination call, and adherence verification is timestamped and recorded for audit purposes.

Question 6

How does 42 CFR Part 2 affect APCM enrollment?

Accepted Answer

42 CFR Part 2 requires specific, written consent for the disclosure of SUD records. When enrolling patients in APCM, practices must ensure that their care management platform—including AI call centers—is configured to handle these restricted records with the appropriate level of confidentiality and consent management.

Question 7

Do AI call centers need specific SUD consent?

Accepted Answer

Yes. Any third-party service handling SUD patient data must be covered by a Business Associate Agreement (BAA) and specific 42 CFR Part 2 compliant consent forms. Tile Healthcare's AI is designed to trigger consent verification before discussing any sensitive MAT or recovery details with the patient.

Question 8

How is patient privacy maintained during automated check-ins?

Accepted Answer

Privacy is maintained through end-to-end encryption and secure authentication protocols. AI systems use voice recognition or PIN verification to ensure they are speaking with the patient before disclosing MAT adherence schedules or discussing relapse prevention strategies, mirroring the strict protocols of a physical clinic.

Question 9

What happens if a patient revokes consent for APCM?

Accepted Answer

If a patient revokes consent, the AI system must immediately cease all automated outreach and flag the record in the EHR. Because APCM relies on continuous engagement, revoking consent typically ends the practice's ability to bill for those management codes for that specific patient.

Question 10

Are there specific audit risks for SUD billing?

Accepted Answer

The primary risks involve lack of documentation for the required minutes of care and failure to obtain updated 42 CFR Part 2 consents. Automated systems mitigate this by providing a digital paper trail of every patient interaction, ensuring that all billing is supported by verifiable clinical activity.

Question 11

How does AI improve MAT adherence?

Accepted Answer

AI improves adherence by providing consistent, non-judgmental check-ins. Automated calls can remind patients of buprenorphine or methadone appointments, screen for withdrawal symptoms, and provide immediate escalation to a human clinician if a patient reports a high risk of relapse.

Question 12

Can automated calls handle relapse prevention?

Accepted Answer

While AI cannot replace a counselor, it can execute structured relapse prevention protocols. By asking validated screening questions about cravings and stress levels, the AI can identify early warning signs and schedule emergency counseling sessions before a lapse occurs.

Question 13

How are co-occurring mental health issues tracked?

Accepted Answer

AI workflows incorporate PHQ-9 and GAD-7 screenings into regular APCM check-in calls. This data is automatically fed into the patient's chart, allowing providers to monitor the intersection of substance use and mental health, which is critical for successful long-term recovery.

Question 14

What role does naloxone coordination play in APCM?

Accepted Answer

APCM care plans for OUD must include overdose prevention. AI systems can verify that a patient has a current naloxone kit, provide instructions on how to use it, and coordinate refills with the pharmacy, ensuring this life-saving component of care is never overlooked.

Question 15

How do we handle detox follow-ups via automation?

Accepted Answer

The first 72 hours post-detox are critical. AI systems can be programmed for high-frequency outreach during this window, ensuring the patient has transitioned to their MAT provider and is stable, significantly reducing the high rates of early treatment drop-out.

APCM Billing & Enrollment FAQ for SUD | Tile Healthcare

APCM Billing & Coding (G0568-G0570)

42 CFR Part 2 & Compliance

MAT Patient Engagement & Retention

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