Additional Substance Use Disorder (SUD) Treatment Services to Be a Benefit of Texas Medicaid

Transcription

1 Additinal Substance Use Disrder (SUD) Treatment Services t Be a Benefit f Texas Medicaid Infrmatin psted Nvember 12, 2010 Effective fr dates f service n r after January 1, 2011, additinal substance use disrder (SUD) treatment services will be a benefit f Texas Medicaid. The additinal SUD treatment services include residential detxificatin, ambulatry (utpatient) detxificatin, and residential treatment. The residential detxificatin and residential treatment benefits will apply t clients in the fllwing prgrams: Primary Care Case Management Fee-fr-Service STAR Medicaid managed care prgram STAR+PLUS Medicaid managed care prgram. Ambulatry detxificatin was made a benefit nly fr clients enrlled in STAR and STAR+PLUS Medicaid managed care prgrams effective September 1, Ambulatry detxificatin will becme available t Primary Care Case Management and Fee fr Service clients effective January 1, These benefits will be extended t clients f all ages. Clients wh are 20 years f age and yunger already have access t these benefits thrugh Texas Medicaid. Reminder: Effective September 1, 2010, the fllwing SUD treatment services were made a benefit f Texas Medicaid: assessment, utpatient treatment, and medicatin assisted therapy. Als effective September 1, 2010, ambulatry detxificatin was made a benefit nly fr clients enrlled in STAR and STAR+PLUS Medicaid managed care prgrams. Nte: STAR and STAR+PLUS Medicaid managed care health plans may r may nt mirrr the billing requirements presented in this article. This article applies t clients in Primary Care Case Management and Fee fr Service Medicaid. Cntact the client s STAR r STAR+PLUS health plan fr mre infrmatin n specific billing and prir authrizatin requirements. Detxificatin Services Overview SUD detxificatin services must be prvided by a chemical dependency treatment facility (CDTF) that is licensed and regulated by the Department f State Health Services (DSHS) t prvide SUD services within the scpe f that facility s DSHS license. Detxificatin services are a set f interventins that are aimed at managing acute physilgical substance dependence. Accrding t the Texas Administrative Cde (TAC) detxificatin services include, but are nt limited t, the fllwing cmpnents: Evaluatin Mnitring Medicatin

2 Daily interactins Clients wh are admitted t a detxificatin prgram must meet the Diagnstic and Statistical Manual f Mental Disrders, Furth Editin, Text Revisin (DSM-IV-TR) criteria fr physilgical substance dependence and must meet the admissin requirements based n a natinally recgnized standard. Services and prvider requirements that are assciated with this benefit can be fund in Texas Department f Insurance (TDI) regulatins (28 Texas Administrative Cde [TAC], part 1 chapter 3 subchapter HH and TAC ). Medical necessity fr substance use disrder services will be determined based n the TDI regulatins and natinally recgnized standards, such as thse frm the American Sciety f Addictin Medicine (ASAM) r the Center fr Substance Abuse Treatment (CSAT). Crisis stabilizatin is nt a cmpnent f detxificatin; hwever, crisis stabilizatin fr a mental health cnditin may be prvided under a client s mental health benefits as needed if the service is medically necessary and the clinical criteria fr psychiatric care are met. The fllwing SUD services are nt a benefit f Texas Medicaid: Detxificatin services fr hashish, ccaine, r marijuana addictin Detxificatin with an piid when the client has had tw r mre unsuccessful piid detxificatin episdes (has left the prgram against medical advice) within a twelve-mnth perid (see 42 Cde f Federal Regulatins (CFR) 8) Detxificatin r substance abuse cunseling services that are prvided by electrnic means (e.g., telemedicine, , r telephne) Effective January 1, 2011, the fllwing SUD services prcedure cdes will be a benefit f Texas Medicaid: Prcedure Cdes H0016 H0031 H0032 H0047 H0050 H2017 H2035 S9445 Prcedure cdes H0016, H0031, H0032, H0047, H0050, H2017, H2035, and S9445 may be reimbursed t a CDTF. Ambulatry (Outpatient) Detxificatin Ambulatry (utpatient) detxificatin (prcedure cde H0016) requires prir authrizatin and is apprpriate when the client s medical needs d nt require clse mnitring. Prcedure cdes H0016, H0050 and S9445 must be used when billing fr ambulatry (utpatient) detxificatin alng with mdifier HF. Ambulatry (utpatient) detxificatin is limited t nce per day. Ambulatry (utpatient) detxificatin is nt a stand-alne service and must be prvided in cnjunctin with ambulatry substance use treatment services. Prcedure cde H0050 will nly be reimbursed nce a day, regardless f the time spent with the client.

3 Ambulatry (utpatient) detxificatin (prcedure cdes H0050 and S9445) will be denied if billed withut prcedure cde H0016. Residential Detxificatin Residential detxificatin (prcedure cde H2017) requires prir authrizatin. Residential detxificatin is apprpriate when a client s medical needs d nt warrant acute inpatient hspital admissin, but the severity f the anticipated withdrawal requires clse mnitring. Medically supervised hspital inpatient detxificatin is apprpriate when ne f the fllwing criteria is met: The client has cmplex medical needs r cmplicated cmrbid cnditins that necessitate hspitalizatin fr stabilizatin. The services that are prvided t a client are incidental t ther medical services that are prvided as a part f an acute care hspital stay. Prcedure cde H0031, H0032, H0047, H2017, r S9445 must be used when billing fr residential detxificatin alng with mdifier HF. Residential detxificatin (prcedure cde H0031, H0032, H2017, r S9445) is limited t nce per day. Prcedure cde H2017 will nly be reimbursed a flat fee nce a day, regardless f the time spent with the client. Residential detxificatin (prcedure cdes H0031, H0032, H0047, r S9445) will be denied if billed withut prcedure cde H2017. Rm and bard fr residential detxificatin (prcedure cde H0047) is limited t nce per episde f care. Prcedure cde H0047 may be reimbursed fr clients wh are 21 years f age and lder as an access based fee. Fr clients wh are 20 years f age and yunger, prcedure cde H0047 shuld be billed as an infrmatinal detail. Residential Treatment Residential treatment (prcedure cde H2035) may be a benefit f Texas Medicaid when prvided by a CDTF in a residential facility. Residential treatment requires prir authrizatin and may be authrized fr up t 35 days per episde f care, with a maximum f tw episdes f care per rlling six-mnth perid and fur episdes f care per rlling year (12 mnths frm the date f service). Residential treatment services include cunseling and psycheducatin. Residential treatment must be billed using prcedure cdes H0047 and H2035 alng with mdifier HF. Residential treatment (prcedure cde H2035) is limited t nce per day. Residential treatment prcedure cde H0047 will be denied if billed withut prcedure cde H2035. Prir Authrizatin Requirements Prir authrizatin is required fr the fllwing services:

4 Ambulatry (utpatient) detxificatin services Residential detxificatin services Residential treatment services Prir authrizatin fr ambulatry r residential detxificatin r treatment services will nt be issued fr clients wh are 13 years f age and yunger unless the request is accmpanied by a waiver frm the Department f State Health Services (DSHS) Regulatry and Licensing Divisin. Authrizatin will be cnsidered fr the least restrictive envirnment apprpriate t the client's medical need as determined in the client's plan f care and based n natinal standards. Prviders must submit the apprpriate prir authrizatin request frm fr the initial r cntinuatin f ambulatry (utpatient) r residential detxificatin treatment and residential treatment services. Prviders must submit ne f the fllwing frms t btain prir authrizatin: Ambulatry (utpatient) Detxificatin Authrizatin Request Frm Residential Substance Abuse Treatment Authrizatin Request Frm Residential Detxificatin Authrizatin Request Frm Effective December 17, 2010, the authrizatin frms will be available n the TMHP website at under Texas Medicaid/Frms. The primary prcedure cde (H0016, H2017, r H2035) must be dcumented n the prir authrizatin request frm. The prir authrizatin prcedure t fllw depends n the prgram in which the client is enrlled, as shwn in the fllwing table: Prgram Fee-fr-Service Prir Authrizatin Prcess Prir authrizatin requests fr substance use disrder services may be submitted t the TMHP Prir Authrizatin Unit n the TMHP website, by fax at r by mail t: Texas Medicaid & Healthcare Partnership TMHP Prir Authrizatin Department B Riata Trace Parkway, Suite 150 Austin TX Prviders may cntact the TMHP Prir Authrizatin Unit by telephne at , Optin 2, t btain infrmatin abut substance use disrder benefits, the prir authrizatin prcess, r the status f a prir authrizatin request. Prir authrizatin fr substance use disrder services cannt be btained thrugh this line. Requests fr a cntinuatin f services must be received n r befre the last day that was authrized r denied. When the TMHP Prir Authrizatin Unit ntifies the prvider by fax and the date f the determinatin letter is n r after the last date authrized r denied, the request fr cntinuatin is due by 5:00 p.m., Central Time f the next business day.

5 Prgram PCCM STAR and STAR+PLUS Prir Authrizatin Prcess Requests fr a cntinuatin f services will be denied if they are nt received n r befre the last day f the current authrizatin perid. Online prir authrizatin requests fr substance use disrder services are nt currently available. Prviders will be ntified in a future ntificatin when prir authrizatin requests fr substance use disrder services can be submitted nline. Authrizatin fr PCCM urgent r emergent inpatient detxificatin services must be btained befre submissin f the claim. Scheduled PCCM inpatient admissins fr detxificatin require authrizatin befre admissin. Prir authrizatin requests fr PCCM clients may be submitted t the PCCM Outpatient Prir Authrizatin Department n this website, by telephne at , r by fax at Generally, prir authrizatin and extensins fr Medicaid managed care clients in STAR r STAR+PLUS are handled by the client s health plan. Cntact the client s health plan fr mre infrmatin. Prir authrizatin is nt required fr substance use disrder services fr dual eligible clients enrlled as STAR PLUS MQMBs. The fllwing sectins define the admissin and cntinued stay criteria fr ambulatry (utpatient) detxificatin, residential detxificatin, and residential treatment. Admissin Criteria fr Ambulatry (Outpatient) Detxificatin T be cnsidered eligible fr treatment in an ambulatry detxificatin service, a client must meet the fllwing cnditins: Chemical substance withdrawal The individual is expected t have a stable withdrawal frm alchl r drugs The diagnsis must meet the criteria fr the definitin f substance (chemical) dependence, as detailed in the mst current revisin f the ICD-9-CM, r the mst current revisin f the Diagnstic and Statistical Manual fr Prfessinal Practitiners, accmpanied by evidence that sme f the symptms have persisted fr at least ne mnth r have ccurred repeatedly ver a lnger perid f time. Medical functining The client must meet all f the fllwing criteria: N histry f recent seizures r past histry f seizures during withdrawal. N clinical evidence f altered mental state as manifested by disrientatin t self, alchlic hallucinatins, txic psychsis, r altered level f cnsciusness (clinically significant btundatin, stupr, r cma). The symptms are due t withdrawal and nt due t a general medical cnditin. Absence f any presumed new asymmetric r fcal findings (i.e., limb weakness, clnus, spasticity, unequal pupils, facial asymmetry, eye cular mvement paresis, papilledema, r lcalized cerebellar dysfunctin, as reflected in asymmetrical limb crdinatin).

6 Stable vital signs as interpreted by a physician. The client must als be withut a previus histry f cmplicatins frm acute chemical substance withdrawal and judged t be free f a health risk as determined by a physician. N evidence f a cexisting serius injury r systemic illness either newly discvered r prgressive in nature. Absence f serius disulfiram-alchl (Antabuse) reactin with hypthermia, chest pains, arrhythmia, r hyptensin. Clinical cnditin that allws fr a cmprehensive and satisfactry assessment. Family, scial, academic dysfunctin The client must meet at least ne f the fllwing criteria with regards t family, scial, and academic dysfunctin: The client's scial system and significant ther(s) are supprtive f recvery t the extent that the client can adhere t a treatment plan and treatment service schedules withut substantial risk f reactivating the client's addictin. The client's family r significant ther(s) are willing t participate in the ambulatry (utpatient) detxificatin treatment prgram. The client may r may nt have a primary r scial supprt system t assist with immediate recvery, but the client has the scial skills t btain such a supprt system r t becme invlved in a self-help fellwship. The client des nt live in an envirnment where licit r illicit md altering substances are being used. Emtinal and behaviral status The client must meet all f the fllwing criteria with regards t emtinal and behaviral status: Client is cherent, ratinal, and riented fr treatment. The mental state f the client des nt preclude the client's ability t cmprehend and understand the materials presented, and the client is able t participate in the ambulatry detxificatin treatment prcess. Dcumentatin exists in the medical recrd that the client expresses an interest t wrk tward ambulatry detxificatin treatment gals. Client has n neurpsychiatric cnditin that places client at imminent risk f harming self r thers (e.g. pathlgical intxicatin r alchl idisyncratic intxicatin). Client has n neurlgical, psychlgical, r uncntrlled behavir that places the client at imminent risk f harming self r thers (depressin, anguish, md fluctuatins, verreactins t stress, lwer stress tlerance, impaired ability t cncentrate, limited attentin span, high level f distractibility, negative emtins, r anxiety). Client has n dcumented DSM-IV axis I cnditin r disrder that, in cmbinatin with alchl r drug use, cmpunds a pre-existing r cncurrent emtinal r behaviral disrder and presents a majr risk t the client

7 The client has n mental cnfusin r fluctuating rientatin. Chemical substance use The client must meet the criteria in at least ne f the fllwing cnditins fr recent chemical substance use: The client's chemical substance use is excessive, and the client has attempted t reduce r cntrl it but has been unable t d s (as lng as chemical substances are available). The client is mtivated t stp using alchl r drugs and is in need f a supprtive structured treatment prgram t facilitate withdrawal frm chemical substances. Cntinued Stay Criteria fr Ambulatry (Outpatient) Detxificatin A client is cnsidered eligible fr cntinued stay in the ambulatry detxificatin treatment service when the client meets at least ne f the cnditins fr either chemical substance withdrawal r psychiatric r medical cmplicatins Prir authrizatin fr ambulatry (utpatient) treatment services beynd the annual limitatin f 135 hurs f grup services and 26 hurs f individual services per calendar year, may be cnsidered fr clients wh are 20 years f age and yunger with dcumentatin frm a physician (wh des nt need t be affiliated with the CDTF) f the supprting medical necessity fr cntinued treatment services. Requests must be submitted befre prviding the extended services. The dcumentatin must include the fllwing infrmatin: The client is meeting treatment gals. The client demnstrates insight and understanding int relatinship with md altering chemicals, but cntinues t present with issues addressing the life functins f wrk, scial, r primary relatinships withut the use f md-altering chemicals. One f the fllwing: Althugh physically abstinent frm chemical substance use, the client remains mentally preccupied with such use t the extent that the client is unable adequately t address primary relatinships r scial r wrk tasks. Nevertheless, there are indicatins that, with cntinued treatment, the client will effectively address these issues. Althugh ther psychiatric r medical cmplicatins exist that affect the client's treatment, dcumentatin exists that the client cntinues t shw treatment prgress and that there is evidence t supprt the benefits f cntinued treatment. Chemical substance withdrawal Client, while physically abstinent frm chemical substance use, is exhibiting incmplete stable withdrawal frm alchl r drugs, as evidenced by psychlgical and physical cravings. Client, while physically abstinent frm chemical substance use, is exhibiting incmplete stable withdrawal frm alchl r drugs, as evidenced by significant drug levels. Psychiatric r medical cmplicatins

8 Dcumentatin in the medical recrd indicates an intervening medical r psychiatric event that was serius enugh t interrupt ambulatry detxificatin treatment, but als that the client is again prgressing in treatment. Admissin Criteria fr Residential Detxificatin Detxificatin services may be authrized fr up t 21 days. The level f service and number f days authrized will be based n the substance(s) f abuse, level f intxicatin and withdrawal ptential, and the client's medical needs. Requests fr detxificatin services fr clients wh are 20 years f age and yunger and wh need mre than 21 days f residential detxificatin require Medical Directr review with dcumentatin f medical necessity frm a physician familiar with the client. Clients are eligible fr admissin t a residential detxificatin service when they have failed tw previus individual treatment episdes f ambulatry (utpatient) detxificatins r when they have a diagnsis that meets the criteria fr the definitin f chemical dependence, as detailed in either the mst current revisin f the ICD-9-CM, r the mst current revisin f the Diagnstic and Statistical Manual fr Prfessinal Practitiners. In additin, the client must meet at least ne f the fllwing criteria fr chemical substance withdrawal, majr medical cmplicatin, r majr psychiatric illness fr admissin t residential treatment fr detxificatin: Chemical substance withdrawal Impaired neurlgical functins as evidenced by: Extreme depressin (e.g., suicidal). Altered mental state with r withut delirium as manifested by disrientatin t self; alchlic hallucinsis, txic psychsis, altered level f cnsciusness, as manifested by clinically significant btundatin, stupr, r cma. Histry f recent seizures r past histry f seizures n withdrawal. The presence f any presumed new asymmetric and/r fcal findings (i.e., limb weakness, clnus, spasticity, unequal pupils, facial asymmetry, eye cular mvement paresis, papilledema, r lcalized cerebellar dysfunctin, as reflected in asymmetrical limb incrdinatin). Unstable vital signs cmbined with a histry f past acute withdrawal syndrmes that are interpreted by a physician t be indicatin f acute alchl r drug withdrawal. Evidence f cexisting serius injury r systemic illness, newly discvered r prgressive. Clinical cnditin (e.g., agitatin, intxicatin, r cnfusin) that prevents satisfactry assessment f the abve cnditins and indicates placement in residential detxificatin service may be justified. Neurpsychiatric changes f such severity and nature that they put the client at imminent risk f harming self r thers (e.g., pathlgical intxicatin r alchl idisyncratic intxicatin, etc.).

9 Serius disulfiram-alchl (Antabuse) reactin with hypthermia, chest pains arrhythmia, r hyptensin. Majr Medical Cmplicatins The individual must present a dcumented cnditin r disrder that, in cmbinatin with alchl r drug use, presents a determined health risk (e.g., gastrintestinal bleeding, gastritis, severe anemia, uncntrlled diabetes mellitus, hepatitis, malnutritin, cardiac disease, hypertensin, etc.). Majr psychiatric illness The client must meet at least ne f the fllwing cnditins with regards t majr psychiatric illness: Dcumented DSM III-R AXIS I cnditin r disrder that, in cmbinatin with alchl r drug use, cmpunds a preexisting r cncurrent emtinal r behaviral disrder and presents a majr risk t the individual. Severe neurlgical and psychlgical symptms: (e.g., anguish, md fluctuatins, verreactins t stress, lwered stress tlerance, impaired ability t cncentrate, limited attentin span, high level f distractibility, extreme negative emtins, r extreme anxiety). Danger t thers r hmicidal. Uncntrlled behavir that endangers self r thers, r dcumented neurpsychiatric changes f a severity and nature that place the individual at imminent risk f harming self r thers. Mental cnfusin r fluctuating rientatin. Cntinued Stay Criteria fr Residential Detxificatin Eligibility fr cntinued stay fr residential detxificatin services is based n the client meeting at least ne f the criteria fr chemical substance withdrawal, majr medical cmplicatins, r majr psychiatric cmplicatins. Chemical substance withdrawal Incmplete medically stable withdrawal frm alchl r drugs, as evidenced by dcumentatin f at least ne f the fllwing cnditins: Unstable vital signs. Cntinued disrientatin. Abnrmal labratry findings related t chemical dependency. Cntinued cgnitive deficit related t withdrawal s that the client is unable t recgnize alchl r drug use as a prblem. Labratry finding that, in the judgment f a physician, indicates that a drug has nt sufficiently cleared the client's system. Majr Medical Cmplicatins Dcumentatin in the medical recrd must indicate that a medical cnditin r disrder (e.g., uncntrlled diabetes mellitus) cntinues t present a health risk and is actively being treated.

10 Majr Psychiatric Cmplicatins The client must meet at least ne f the fllwing: Dcumentatin in the medical recrd that a DSM III-R AXIS I psychiatric cnditin r disrder that, in cmbinatin with alchl r drug use, cntinues t present a majr health risk, is actively being treated. Dcumentatin in the medical recrd that severe neurlgical r psychlgical symptms have nt been satisfactrily reduced but are actively being treated. Admissin Criteria fr Residential Treatment The diagnsis meets the criteria fr the definitin f chemical dependence, as detailed in the mst current revisin f the ICD-9-CM, r the mst current revisin f the Diagnstic and Statistical Manual fr Prfessinal Practitiners, accmpanied by evidence that sme f the symptms have persisted fr at least ne mnth r have ccurred repeatedly ver a lnger perid f time. Clients must meet the fllwing cnditins in rder t receive treatment in a residential treatment service prgram: Medical functining The fllwing must be present fr medical functining: Dcumented medical assessment fllwing admissin (except in instances where the client is being referred frm an inpatient service) indicates that the client is medically stable and nt in acute withdrawal. The client is nt bed-cnfined and has n medical cmplicatins that wuld hamper participatin in the residential service Family, Scial, r Academic Dysfunctin and Lgistic Impairments At least ne f the fllwing must be present fr family, scial, r academic dysfunctin and lgistic impairment: The client manifests severe scial islatin r withdrawal frm scial cntacts. The client lives in an envirnment (scial and interpersnal netwrk) in which treatment is unlikely t succeed (e.g., a chatic family dminated by interpersnal cnflict, which undermines client's effrts t change). Client's family r significant ther(s) are ppsed t the client's treatment effrts and are nt willing t participate in the treatment prcess. Family members r significant ther(s) living with the client manifest current chemical dependence disrders and are likely t undermine treatment. Lgistic impairments (e.g., distance frm treatment facility r mbility limitatins) preclude participatin in a partial hspitalizatin r ambulatry (utpatient) treatment service. Emtinal and Behaviral Status The client must meet all three f the fllwing criteria fr emtinal and behaviral status: Client is cherent, ratinal, and riented fr treatment.

11 Mental state f the client des nt preclude the client's ability t cmprehend and understand the materials presented and participate in rehabilitatin r treatment prcess. The medical recrd cntains dcumentatin that with cntinued treatment the client will be able t imprve r internalize the client's mtivatin tward recvery within the recmmended length f stay time frames (e.g., becming less defensive, verbalizing, and wrking n alchl r drug related issues). Interventins, treatment gals, r cntracts are in place t help the client deal with r cnfrnt the blcks t treatment (e.g., family interventin r emplyee cunseling cnfrntatin). Chemical Substance Use The client must meet at least ne f the fllwing criteria fr chemical substance use: The client's chemical substance use is excessive, and the client has attempted t reduce r cntrl it but has been unable t d s (as lng as chemical substances are available). Virtually all f the client's daily activities revlve arund btaining, using, r recuperating frm the effects f chemical substances, and the client requires a secured envirnment t cntrl the client's access t chemical substances. Clients wh are 13 thrugh 17 years f age must meet all abve cnditins and the fllwing cnditins in rder t receive treatment in an adlescent residential treatment service prgram. At the maturatin level, the adlescent client must meet bth f the fllwing criteria: The client is assessed as manifesting physical maturatin at least in middle adlescent range (i.e., pst-pubescent; nt grwth-retarded). The histry f the adlescent reflects cgnitive develpment f at least 11 years f age. The adlescent client must display at least ne f the fllwing with regards t develpmental status: Dcumented histry f inability t functin within the expected age nrms despite nrmal cgnitive and physical maturatin (e.g., refusal t interact with family members, vert prstitutin, felny, r ther criminal charges). A recent histry f mderate t severe cnduct disrder, as defined in the Diagnstic and Statistical Manual fr Prfessinal Practitiners, r impulsive disregard fr scial nrms and rights f thers. Dcumented difficulty in meeting develpmental expectatins in a majr area f functining (e.g., scial, academic, r psychsexual) t an extent that interferes with the capacity t remain behavirally stable. Cntinued Stay Criteria fr Residential Treatment At least ne f the fllwing cnditins must be present fr cntinued stay in a residential treatment prgram: Chemical dependency rehabilitatin r treatment cmplicatins:

12 The client recgnizes r identifies with the severity f the alchl r drug prblem but demnstrates minimal insight int the client's defeating the use f alchl r drugs. Hwever, dcumentatin in the medical recrd indicates that the client is prgressing in treatment. The client identifies with the severity f the alchl r drug prblem and manifests insight int the client s persnal relatinship with md-altering chemicals, yet des nt demnstrate behavirs that indicate the develpment f prblem-slving skills that are necessary t cpe with the prblem. The client wuld predictably relapse if mved t a lesser level f care. Psychiatric r medical cmplicatins: Dcumentatin in the medical recrd indicates an intervening medical r psychiatric event that was serius enugh t interrupt rehabilitatin r treatment, but the client is again prgressing in treatment. Dcumentatin in the medical recrd indicates that the client is being held pending an immediate transfer t a psychiatric, acute medical service, r inpatient detxificatin alchl r drug service. Reimbursement Limitatins Ambulatry (utpatient) treatment (prcedure cdes H0004 and H0005) will be denied if billed n the same date f service as residential detxificatin prcedure cdes H0031, H0032, H0047, H2017r residential treatment prcedure cde H2035. Medicatin assisted therapy (prcedure cdes H0020 and H2010) will be denied as part f anther service when billed fr the same date f service as prcedure cdes H0016, H0031, H0032, H0047, H0050, H2017, H2035, r S9445.