SUD APCM Billing & Coding Setup Checklist

Ensure patient consent specifically mentions APCM-related data exchange between addiction specialists and primary care under 42 CFR Part 2.

Use automated voice prompts to verify patient identity before discussing sensitive MAT or SUD treatment details over the phone.

Document how behavioral health integration data is captured and shared between the AI platform and the EMR for billing.

Limit visibility of APCM billing codes and associated clinical notes to authorized personnel only to maintain confidentiality.

Create workflows for patients to opt-in or out of specific communication channels like SMS or automated voice check-ins.

Ensure SUD treatment records are siloed from general medical records unless explicit consent is provided for APCM coordination.

Program the AI to call OUD patients 48 hours before their buprenorphine refill is due to confirm appointment attendance.

Use automated outreach to confirm patients have active naloxone kits and provide renewal reminders when prescriptions expire.

Configure AI sentiment analysis to flag high-risk keywords during routine check-ins, alerting the clinical team immediately.

Integrate PHQ-9 or GAD-7 screening questions into automated monthly APCM phone check-ins for SUD patients.

Ensure the AI call system can immediately escalate 'relapse' or 'withdrawal' keywords to a live clinician or crisis center.

Use AI to screen for transportation or housing barriers that might impede MAT adherence during APCM calls.

Ensure the 2026 BHI add-on codes are active in your billing system for proper APCM revenue capture in SUD settings.

Categorize patients by SUD severity and co-occurring conditions to select the appropriate APCM billing level.

Use AI call logs to automatically document time spent on non-face-to-face care coordination for billing audits.

Create templates that link MAT management activities to the specific requirements of the G0568-G0570 code set.

Run automated insurance checks to ensure patients are covered under Medicare Part B for APCM and BHI services.

Compare AI call volume and clinical outreach logs against processed APCM claims to identify revenue leakage.