Substance Abuse Rehab
Provider Representative: Karen Murphy Tel.(571) 348-5933
email:Karen.Murphy3@gainwelltechnologies.com
Reference Guide
Updates
July 2025
Effective July 1, 2025, Substance Abuse Residential Service (SUD Res) rates were increased, see table below. Claims previously submitted that were paid the old rate will be mass adjusted. The mass adjusted claims will be in a September 2025 remittance advice.
| ASAM Level | Code/Mod | Old Rate | New Rate |
| 3.1 | H0018 UD | $202.80 | $218.23 |
| 3.5 | H0010 UD | $361.17 | $388.66 |
| 3.7 | H0011 UD | $596.23 | $641.60 |
December 2024
Changes to the Medicaid Fee for Service (FFS) billing for SUD Residential was implemented in December 2024.
| ASAM Level | Code/Mod | Rate |
| 3.1 | H0018 UD | $202.80 |
| 3.5 | H0010 UD | $361.17 |
| 3.7 / 3.7 WM | H0011 UD | $596.23 |
These new codes have a retro effective date of October 1, 2024. SUD Residential services will continue to be billed to RI Medicaid FFS on the 837 Professional transaction or the paper CMS 1500 claim form. SUD Residential claims will be billed with Taxonomy 324500000X – Residential Treatment Facility.
RI Medicaid/OHHS recouped all billing (of codes H0001 UD, H0004 UD, H0005 UD) from 10/1/2024 through mid-December. This recoupment was posted on the Remittance Advice dated December 27, 2024. If you have billed a BLOCK Grant, the recoupment will be handled separately at a later date.
For services from 10/1/24 onward, providers must rebill these services with the new code combinations, to receive the new per diem rates effective 10/1/24.
For any questions, please feel free to contact Provider Representative, Karen Murphy at karen.murphy3@gainwelltechnologies.com or 571-348-5933.