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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) : 8.11 Noncovered Services

8.11
The following SUD services are not a benefit of Texas Medicaid:
Services for which the client fails to meet the treatment eligibility or authorization criteria, or which are not clinically appropriate in the setting requested based on the client’s medical condition
Detoxification with an opioid when the client has had two or more unsuccessful opioid detoxification episodes (has left the program against medical advice) within a 12-month period (see 42 CFR Section 8)

Texas Medicaid & Healthcare Partnership
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