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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) : 8.10 Reimbursement and Limitations : 8.10.2 Treatment Services

Ambulatory (outpatient) treatment (procedure codes H0004 and H0005) is reimbursed at a time-based rate.
Ambulatory (outpatient) treatment services are limited to 135 hours of group counseling and 26 hours of individual counseling per calendar year when provided by a CDTF.
Residential treatment services (procedure code H2035) are limited to one per day and are allowed up to a maximum of 35 days.
Ambulatory (outpatient) treatment (procedure codes H0004 and H0005) will be denied if billed on the same date of service as residential detoxification (procedure codes H0012, H0031, H0047, and T1007) or residential treatment (procedure code H2035).
Procedure code H0047 will be denied if billed without procedure code H2035.

Texas Medicaid & Healthcare Partnership
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