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2012 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8. Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.9 Reimbursement and Limitations

8.9
8.9.1
Inpatient detoxification is reimbursed by the reimbursement methodology specific to the inpatient hospital. Separate reimbursement may be provided for physician services performed during an inpatient stay.
Residential detoxification and treatment services are considered outpatient services for the purposes of reimbursement and should be billed accordingly.
Residential detoxification (procedure codes H0012, H0031, S9445, and T1007) are limited to once per day.
Residential detoxification (procedure codes H0031, H0047, S9445, or T1007) will be denied if billed without procedure code H0012.
Room and board for residential detoxification and treatment (procedure code H0047) is limited to once per date of service. Procedure code H0047 is reimbursed for clients who are 21 years of age and older as an access-based fee, and as an informational detail for clients who are 20 years of age and younger.
Ambulatory (outpatient) detoxification (procedure codes H0016, H0050, and S9445) are limited to once per day and may be reimbursed on the same date of service as ambulatory (outpatient) SUD treatment by the same or different provider when medically necessary and identified in the client’s treatment plan. For services rendered in the CDTF setting, providers must use the HF modifier.
Ambulatory (outpatient) detoxification (procedure codes H0050 and S9445) will be denied if billed without procedure code H0016.
Separate reimbursement may be provided for physician services during a residential stay.

Texas Medicaid & Healthcare Partnership
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