Summary & Overview
HCPCS T1007: Alcohol and Substance Abuse Treatment Plan Development
HCPCS Level II code T1007 denotes alcohol and/or substance abuse treatment plan development and/or modification. This code captures clinician time spent creating, updating, or revising individualized treatment plans for patients receiving services for substance use disorders. Nationally, structured documentation and appropriate coding for treatment planning are important for care coordination, compliance with payer requirements, and continuity of behavioral health services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, common places of service, and the payer landscape. The publication addresses reimbursement benchmarks where available, typical billing practices, and policy considerations affecting coverage and medical necessity determinations for treatment plan services. It also provides clinical context to help operational and compliance teams align documentation with code use.
This resource is intended for billing managers, behavioral health clinicians, compliance officers, and policy analysts seeking a national perspective on coding for substance use disorder treatment planning.
Billing Code Overview
HCPCS Level II code T1007 represents alcohol and/or substance abuse services specifically for treatment plan development and/or modification. The service type is behavioral health treatment planning, involving assessment-driven creation or revision of individualized treatment plans for patients with substance use disorders. The typical site of service is outpatient behavioral health or community-based treatment settings, including specialty substance use disorder programs and outpatient clinics.
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Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a history of opioid use disorder presents to an outpatient behavioral health clinic for an initial comprehensive treatment planning visit. The patient reports recent relapse after a period of abstinence, has positive urine drug screen for opioids, and requests coordinated care for medication-assisted treatment, counseling, and social support. The clinical workflow begins with an intake interview by a licensed clinician (licensed clinical social worker or addiction counselor), review of prior treatment records, administration of screening instruments (e.g., CAGE-AID, ASI-lite), and a focused biopsychosocial assessment. The clinician documents current substance(s) of use, frequency, severity, medical comorbidities, psychiatric history, risk factors (overdose risk, pregnancy), and social determinants (housing, employment). The team develops a written individualized treatment plan outlining goals, measurable objectives, services to be delivered (medication management, individual therapy, group therapy, case management), frequency, responsible providers, anticipated duration, and criteria for modification or discharge. If clinically indicated, the plan is modified during subsequent visits for clinical deterioration, improved stability, or new comorbidities. The service is commonly billed by outpatient behavioral health agencies, community mental health centers, and certified addiction treatment programs. Typical sites of service include outpatient clinic, behavioral health center, community substance use disorder treatment program, and Federally Qualified Health Centers. This activity corresponds to the HCPCS Level II code T1007 for alcohol and/or substance abuse services involving treatment plan development and/or modification and is documented in the medical record as a time- and content-specific treatment planning encounter tied to applicable ICD-10 diagnosis codes and payor requirements.
Coding Specifications
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