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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8 Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.1 Overview

8.1
Treatment for SUD is a benefit of Texas Medicaid. SUD treatment services are age appropriate medical and psychotherapeutic services designed to treat a client’s substance use disorder and restore function. Services and provider requirements associated with this benefit are found in Texas Department of Insurance (TDI) regulations (28 TAC, part 1 subchapter 3 subcategory HH) and TAC §448.902 and must be strictly followed. Medical necessity for substance abuse services will be determined based on the TDI regulations and nationally recognized standards such as those from the American Society of Addiction Medicine (ASAM) or the Center for Substance Abuse Treatment (CSAT).
The following SUD services are a benefit of Texas Medicaid:
Note:
Crisis intervention is not a component of detoxification. Crisis intervention for a mental health condition may be provided as needed when the service is medically necessary and the clinical criteria for psychiatric care are met.
SUD services provided by a CDTF are limited to those provided by facilities that are licensed and regulated by DSHS to provide SUD services within the scope of that facility’s DSHS license.
Intensive outpatient (IOP) services are ambulatory outpatient services that are provided by CDTF providers.
IOP services are benefits of Texas Medicaid. IOP services are available to clients of all ages and include a maximum of 135 hours of group counseling and 26 hours of individual counseling per calendar year.
The modifiers listed in the following table must be used in the appropriate combination for SUD services to identify the services performed:
 

Texas Medicaid & Healthcare Partnership
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