Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8 Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.8 Prior Authorization : 8.8.3 Prior Authorization for Residential Detoxification Treatment Services : Continued Stay Criteria for Residential Detoxification Treatment Services
Eligibility for continued stay for residential detoxification services is based on the client meeting at least one of the criteria for chemical substance withdrawal, major medical complications, or major psychiatric complications.
Chemical Substance Withdrawal
The client must exhibit one of the following conditions with regard to chemical substance withdrawal complications:
Major Medical Complications
For major medical complications, the client must have documentation in the medical record that indicates that a medical condition or disorder (e.g., uncontrolled diabetes mellitus) continues to present a health risk and is being actively treated.
Major Psychiatric Complications
The client must meet at least one of the following with regard to major psychiatric complications:
Documentation in the medical record that a DSM psychiatric condition or disorder that, in combination with alcohol or drug use, continues to present a major health risk, is actively being treated.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.