Substance Use Disorder Services to be a Benefit of Texas Medicaid

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1 Substance Use Disorder Services to be a Benefit of Texas Medicaid Information Posted on August 13, 2010 Effective for dates of service on or after September 1, 2010, the following substance use disorder (SUD) treatment services will be a benefit of Texas Medicaid: assessment, outpatient treatment, and medication assisted therapy. Ambulatory detoxification will be a benefit only for individuals enrolled in STAR and STAR+PLUS Medicaid managed care programs effective September 1, These benefits will be extended to adults who are 21 years of age or older. Children who are 20 years of age or younger already have access to these benefits through Texas Medicaid. Note: Most adult clients residing in Collin, Dallas, Kaufman, Ellis, Navarro, Hunt, and Rockwall counties already have access to substance use disorder treatment benefits through the NorthSTAR program. The following procedure codes will be a benefit of Texas Medicaid for SUD services: Procedure Codes H0001 H0004 H0005 H0020 H2010 Procedure codes H0020 and H2010 may be reimbursed to physicians when services are rendered in the office, inpatient, and outpatient settings. Procedure codes H0001, H0004 and H0005 may be reimbursed to a chemical dependency treatment facility (CDTF) when services are rendered in the outpatient setting. Procedure codes H0001, H0004, H0005, H0020, and H2010 are a benefit of Texas Medicaid for clients of all ages. Age Restriction Changes Effective for dates of service on or after September 1, 2010, procedure codes H0004 and H0005 will be a benefit for clients of all ages. Currently, procedures codes H0004 and H0005 are limited to clients who are 20 years of age or younger. Substance Use Disorder Services SUD treatment services are age-appropriate services that are designed to treat an individual s substance use disorder. The following SUD services will be a benefit of Texas Medicaid: Assessment by a CDTF for admission into a SUD treatment program Ambulatory outpatient SUD treatment services that are provided by a CDTF up to a maximum of 135 hours of group counseling and 26 hours of individual counseling per calendar year Medication-assisted therapy (MAT) in an outpatient setting

2 In general, no prior authorization is required for outpatient SUD treatment services; exceptions are noted later in this article. SUD services that are provided by a CDTF are limited to those provided by facilities that are licensed and regulated by the Department of State Health Services (DSHS) to provide SUD services within the scope of that facility s DSHS license. The following SUD services are not a benefit of Texas Medicaid: Aftercare Services for which the client fails to meet the treatment eligibility or authorization criterion or that are not clinically appropriate in the setting based on the client s medical condition Services for tobacco and caffeine addiction Assessment Clients must be assessed by a Medicaid-enrolled CDTF for treatment services to begin. Clients in fee-for-service Medicaid and Primary Care Case Management (PCCM) can obtain their assessment from any Medicaid-enrolled CDTF. Clients in the State of Texas Access Reform (STAR) or STAR+PLUS managed care programs must go to a CDTF that is in their health plan s network for their assessment. A CDTF assessment must be performed by a qualified, credentialed counselor (as defined by DSHS licensure standards) to determine the severity of an individual s SUD and identify their treatment needs. Assessments are limited to once per episode of care. An assessment must be billed with procedure code H0001. Outpatient Treatment Services Treatment may be provided by a CDTF as an ambulatory (outpatient) service. Note: MAT is a separately identifiable service and may be provided during the treatment period in conjunction with other treatment services. Ambulatory treatment services do not require prior authorization and are limited to 135 hours per year of group services and 26 hours of individual services per calendar year (January through December). Ambulatory (outpatient) treatment services must be billed with procedure codes H0004 and H0005. Procedure code H0004 with modifier HF identifies individual counseling services that are provided in 15-minute increments. Procedure code H0005 with modifier HF identifies group-counseling services that are provided in one-hour increments. Procedure codes H0004 and H0005 are benefits of Texas Medicaid when they are submitted with any of the following diagnosis codes: Diagnosis Description Codes 2919 Unspecified alcohol-induced mental disorders

3 2920 Drug withdrawal Other specified drug-induced mental disorder 2929 Unspecified drug-induced mental disorder Acute alcoholic intoxication, unspecified drunkenness Other and unspecified alcohol dependence, unspecified drunkenness Opioid type dependence, unspecified abuse Sedative, hypnotic, or anxiolytic dependence, unspecified Cocaine dependence, unspecified abuse Cannabis dependence, unspecified abuse Amphetamine and other psychostimulant dependence, unspecified abuse Hallucinogen dependence, unspecified abuse Other specified drug dependence, unspecified abuse Combinations of drug dependence excluding opioid type drug, unspecified abuse Nondependent alcohol abuse, unspecified drunkenness Nondependent cannabis abuse, unspecified Nondependent hallucinogen abuse, unspecified Nondependent opioid abuse, unspecified Nondependent cocaine abuse, unspecified Nondependent amphetamine or related acting sympathomimetic abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, unspecified Medication Assisted Therapy MAT will be a benefit when using a drug or biological that is recognized in the treatment of substance use disorder and provided as a component of a comprehensive treatment program per TAC MAT is also a benefit as a conjunctive treatment regimen for individuals who are addicted to substances that can be abused and who meet the DSM-IV-TR criteria for a substance use disorder. Documentation that supports the medical necessity of MAT must be maintained in the client s medical record per the requirements in 42 CFR 8. Clients who are 18 years of age or younger may not be admitted to narcotic maintenance unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to such treatment. To be eligible for narcotic maintenance treatment, clients who are 18 years of age or younger must have had two documented attempts at short-term detoxification or drug-free treatment. A waiting period of no less than seven days is required between the first and the second shortterm detoxification treatment.

4 MAT for the treatment of opioid addiction must comply with the requirements in 42 CFR 8. MAT services must be billed with procedure codes H0020 and H2010. Procedure code H2010 must be billed with one of the following modifiers for MAT: Modifiers HG Opioid addiction treatment program (use for opioid addiction when using drugs other than methadone) HF Substance abuse program (use for the treatment of non-opioid addiction) Procedure codes H0020 and H2010 are limited to a maximum of one hour (four units) per date of service, for the same procedure, by any provider when rendered in the office or outpatient setting. MAT is reimbursed in 15-minute increments, which is based on the amount of face-toface time spent providing treatment to the client. MAT is limited to one claim per date of service regardless of the number of abused substances being treated. Claims billed for MAT must include the client s substance use disorder diagnosis. Authorization Requirements Authorization Extension Criteria for Ambulatory (Outpatient) Treatment Services Prior authorization is required for ambulatory (outpatient) treatment of clients who are 21 years of age or younger and who exceed the benefit limitation of 135 hours of group services and 26 hours of individual services per calendar year. Providers must submit prior authorization extension requests on the new Ambulatory (Outpatient) Substance Abuse Counseling Extension Request Form. Prior authorization may be considered if a physician (who does not have to be affiliated with the CDTF) provides documentation that supports the medical necessity of continued treatment services. Requests must be submitted before the extended services are provided. The documentation must include the following information: The client is meeting treatment goals. The client demonstrates insight and understanding into his relationship with mood altering chemicals, but continues to present with issues that address the life functions of work, social, or primary relationship without the use of mood-altering chemicals. The client is physically abstinent from chemical substance use, but remains mentally preoccupied with such use to the extent that the client is unable to adequately address primary relationships or social or work tasks, but there are indications that, with continued treatment, the client will effectively address these issues.

5 Documentation that other psychiatric or medical complications exist and affect the client's treatment may be considered, but the client continues to show treatment progress and there is evidence to support the benefits of continued treatment. The following services do not require prior authorization: Ambulatory (outpatient) treatment services for clients who are 21 years of age or younger unless calendar year hours are exceeded MAT Requests for a continuation of services must be received on or before the last day that was authorized or denied. The TMHP Prior Authorization Unit will notify the provider by fax. If the date of the prior authorization unit determination letter is on or after the last date authorized or denied, the request for continuation is due by 5:00 p.m., Central Time of the next business day. Prior authorization requests for fee-for-service clients may be submitted to the Special Medical Prior Authorization (SMPA) department on this website, by fax at , or by mail to: Texas Medicaid & Healthcare Partnership Special Medical Prior Authorization Department B Riata Trace Parkway, Suite 150 Austin TX Authorization will be considered for the least restrictive environment that is appropriate to the client's medical need as determined in the client's plan of care and based on national standards. Prior authorization, except for PCCM urgent or emergent inpatient services, may be considered when it is requested within three business days of admission. Authorization for PCCM urgent or emergent inpatient detoxification services must be obtained before the claim is submitted. Scheduled PCCM inpatient admissions for detoxification require authorization before admission. Services for PCCM clients who require inpatient hospital detoxification may be authorized if: The client has complicated co-morbid conditions that necessitate hospitalization for stabilization. There is limited availability of detoxification services in the client's service area. The client can be effectively treated with appropriate substance abuse services following detoxification. Prior authorization requests for PCCM clients may be submitted to the PCCM Outpatient Prior Authorization Department on this website, by telephone at , or by fax at Note: Prior authorization and extensions for Medicaid managed care clients in STAR or STAR+PLUS are handled by the client s health plan. Contact the client s health plan for more information. Reimbursement Limitations Ambulatory treatment procedure codes H0004 and H0005 are paid at a time-based rate.

6 Procedure code will be denied when billed for the same date of service by the same provider as procedure code H0020 or H2010.

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