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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 : 8.10.3 MAT Services

8.10.3
MAT may be considered for reimbursement on appeal on the same date of service as residential detoxification, ambulatory (outpatient) detoxification, or residential treatment services. For the claim to be considered, providers must:
 
F1120, F1121, F11220, F11221, F11222, F11229, F1123, F1124, F11259, F11281, F11282, F11288, F1129
 
F15120, F15129, F15220, F15229, F15920, F15929, F1610, F1810, F1890, F1910, F551, F553
Claims billed for MAT must include the client’s substance use disorder diagnosis.
Procedure codes H0020 or H2010 will be denied if a claim is submitted for the same date of service as procedure codes H0012, H0016, H0031, H0047, H0050, H2035, S9445, or T1007.
Methadone administration (procedure code H0020) for opioid addiction must be submitted with the following modifiers:
When methadone is administered with supervision in a facility the provider must submit claims using the UA modifier to indicate the facility administered doses
Methadone administration (procedure code H0020) with modifier U1 for unsupervised take home doses must be submitted on the same claim and with the same date of service as methadone administration (procedure code H0020) with modifier UA for supervised facility doses or the take home doses will be denied.
MAT provided in an ambulatory (outpatient) setting (procedure code H0020) is limited to once per date of service, except for unsupervised take home doses (U1 modifier), by any provider and is reimbursed at a fixed daily rate. Reimbursement for procedure code H0020 with modifier U1 is limited to a quantity of 30 per 30 days.
Methadone administration (procedure code H0020) submitted without a modifier will be denied.
Non-methadone (e.g., buprenorphine) administration (procedure code H2010) for opioid addiction must be submitted with the following modifiers:
When non-methadone is administered with supervision in a facility the provider must submit claims using the modifier combination of HG and UA to indicate opioid addiction treatment facility doses or claims will be denied
When non-methadone is dispensed without supervision as a take home dose the provider must submit claims using the modifier combination of HG and U1 to indicate opioid addiction take home doses or claims will be denied
MAT provided in an ambulatory (outpatient) setting (procedure code H2010 with modifier HG and procedure code H2010 with modifier HF), is limited to once per date of service, except for unsupervised take home doses (U1 modifier), by any provider. Reimbursement for procedure code H2010 with modifiers HG and U1 is limited to a quantity of 30 per 30 days.
Non-methadone administration (procedure code H2010-HG) with modifier U1 for unsupervised take home doses must be submitted on the same claim and with the same date of service as non-methadone administration (procedure code H2010-HG) with modifier UA for supervised facility doses or the take home doses will be denied.
When non-methadone is administered in a facility for a non-opioid treatment, providers must use procedure code H2010 with the HF modifier to indicate non-opioid treatment in a facility.
Non-methadone administration (procedure code H2010) submitted without a modifier will be denied. Physician services may be reimbursed separately using the appropriate evaluation and management procedure codes.
Injectable administration is considered part of MAT and is not reimbursed separately. Procedure code 96372 will be denied when billed for the same date of service by any provider as procedure code H0020 or H2010.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee schedules include a column titled “Adjusted Fee” to display the individual fees with all mandated percentage reductions applied.
Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
Note:
Certain rate reductions including, but not limited to, reductions by place of service, client type program, or provider specialty may not be reflected in the Adjusted Fee column.

Texas Medicaid & Healthcare Partnership
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