Medicaid Benefits: Rehabilitation Services – Mental Health and Substance Use
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 43 No - 1 NR - 7 | 2018 data limited to CN | Yes - 8 | Yes - 24 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | No | Varies depending on service | - | - |
| Alaska | Yes | CN | No | Prior authorization required | - | - |
| Arizona | Yes | CN | No | Limitations vary by type of service | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | $1/visit | Coverage limitation vary by service. | - | - |
| Colorado | Yes | CN | No | No | - | - |
| Connecticut | Yes | CN | No | One psychiatric therapy visit of same type per day; no more than eight persons allowed per group therapy session | - | - |
| Delaware | Yes | CN | No | Medically necessary and part of a treatment plan | - | - |
| District of Columbia | Yes | CN | No | Prior authorization required | - | - |
| Florida | No | - | - | |||
| Georgia | Yes | CN | NR | NR | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Medicaid Rehab Option package of services required | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $3.00 per visit | Outpatient substance abuse counseling is limited to 9 hours each 7 day period. | - | - |
| Kentucky | Yes | CN | No | Limits vary by service provided | - | - |
| Louisiana | Yes | CN | No | NR | - | - |
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | Substance abuse treatment limited to 30 weeks | - | - |
| Maryland | Yes | CN | No | Services pre-authorized based on acuity | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | No | - | - |
| Minnesota | Yes | CN | No | No | - | - |
| Mississippi | Yes | CN | No | NR | - | - |
| Missouri | Yes | CN | No | No | - | - |
| Montana | Yes | CN | No | Prior Authorization/Continued stay reviews | - | - |
| Nebraska | Yes | CN | $2 per session for individual, group, and family therapy sessions | No | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | ASAM guided authorization, MH Prior authorization | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | See specific services | - | - |
| North Dakota | Yes | CN | No | Limited to individuals in families that are in crisis with risk of major disruption, to individuals who are at risk of entering or reentering a mental health or hospital facility, services provided by Human Service Center staff that are not otherwise Other Licensed Practitioners, in settings outside the Center, and services provided to individuals who have discharged from inpatient psychiatric treatment. | - | - |
| Ohio | Yes | CN | No | NR | - | - |
| Oklahoma | Yes | CN | $4 per visit | Prior authorization required | - | - |
| Oregon | Yes | CN | No | All coverage is based upon the prioritized list of health services. | - | - |
| Pennsylvania | Yes | CN | Sliding scaled based on the Medicaid fee for service: $0.65 - $3.80 | Limited to Peer Support Services, Mobile Mental Health Treatment, and Mental Health Crisis Intervention Services | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | 5% of payment for mental health services | NR | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | Yes | CN | No | Daily and monthly limits | - | - |
| Utah | Yes | CN | No | No | - | - |
| Vermont | Yes | CN | No | Rehabilitation services in a community mental health center limited to qualified staff carrying out a plan of care and may not duplicate services in another setting; some services have quantity limits; residential treatment facility detoxification treatment limited to 7 days per acute episode and 30 days of post-detoxification services per year, which may be extended up to 183 days per year with approval; substance use disorder services outside of a treatment facility limited to 90 hours of counseling per episode | - | - |
| Virginia | NR | NR | NR | NR | - | - |
| Washington | Yes | CN | No | No | - | - |
| West Virginia | Yes | CN | No | Services based upon medical necessity | - | - |
| Wisconsin | Yes | CN | $0.50 - $3.00 per service for outpatient psychotherapy and substance abuse services - capped at 15 hours or $825, whichever comes first, per calendar year; no copayment for mental health and substance abuse services in the home or community | A small number of services require prior approval. | - | - |
| Wyoming | Yes | CN | No | Prior authorization is required after the first 20 visits to confirm ongoing medical necessity | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 53 No - 3 | Yes - 13 No - 40 | ||||
| Alabama | Yes | CN | Specified set of procedures billable and only for diagnoses in 290-316 range, varying frequency limits | Fee for service | ||
| Alaska | Yes | CN | Residential substance abuse treatment services covered in state-certified facilities only, services in psych residential treatment centers and day treatment services not covered | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | Outpatient psychiatric services limited to 20 sessions/year | |||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Coverage limitations vary by service | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid daily rate |
| Colorado | Yes | CN | $2/visit | Psychotherapy limited to 35 visits/year across all types, substance abuse therapy limited to 25 individual sessions/year and 36 group therapy sessions/year; drug screening and monitoring limited to 36 specimens/year | Fee for service or prospective cost based rate | |
| Connecticut | Yes | CN & MN | 10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment | Prospective per diem or global rate | ||
| Delaware | Yes | CN | 30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Mental health rehab centers must be appropriately certified and state-approved, length of treatment and quantity of covered adult mental health rehab and substance abuse services dependent on established level of acuity | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Quantity and frequency limits vary by service | Capitated payment or fee for service | |
| Georgia | Yes | CN & MN | Fee for service at 84.645% of CMS RBRVS rates for 2000 | |||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Yes | Fee for service or prospective payment system rate | ||
| Idaho | Yes | CN | Psychosocial rehab 5 hours/week, substance abuse therapy 12 individual sessions/ week and 24 group sessions/week | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Limitations vary by service | Yes | Fee for service | |
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Specified substance abuse services | Capitated payment or fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | Services for substance abuse as a primary diagnosis limited to pregnant women | Prospective cost based per diem | ||
| Louisiana | Yes | CN & MN | Substance abuse treatment covered only through Louisiana Behavioral Health Partnership - see state-specific FN | Yes | Capitated payment | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Substance abuse services limited to 30 weeks | Fee for service or negotiated rate | |
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service | |
| Massachusetts | Yes | CN & MN | Fee for service or negotiated rate | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Mental health service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Only FDA-approved substance abuse drugs covered and subject to prescription drug limits and copays, opioid drug therapy limited to 24 cumulative months | Drugs paid in accordance with prescription drug methodology, therapies paid on a fee for service basis | ||
| Missouri | Yes | CN | Fee for service | |||
| Montana | Yes | A & B - See state-specific FN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | $2/visit (specified services) | Services in psychiatric residential treatment facilities not covered for adults | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Community mental health care limited to $1,800/year unless specified criteria met, low service utilizer with severe or persistent mental illness limited to $4,000/year; ambulatory detox services for substance abuse are not covered | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Methadone treatment services covered but not for SCI adults - see state-specific FN | A - authorization required after 7 visits | Fee for service |
| New York | Yes | CN & MN | Beneficiary Specific Utilization Thresholds apply to mental health services - see state-specific FN | Fee for service | ||
| North Carolina | Yes | CN & MN | 8 ambulatory visits | Fee for service or capitated rate | ||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN | Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate, $.50/unit of psychotherapy service | 16 units/day for peer support up to 3,600 units/year, mobile mental health treatment limits vary by service or procedure | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | Negotiated rate | |||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | 5% of payment for mental health services | Substance abuse services limited to pregnant women | Prospective cost based rate | |
| Tennessee | Yes | A, B & C - See state-specific FN | B1 - $5/MH Clinic visit B2 - $15/MH Clinic visit | See state-specific FN | ||
| Texas | Yes | CN & MN | 135 hours for group substance abuse services or 26 hours for individual services; 35 days for residential treatment; 21 days for detox | Residential detox and treatment and ambulatory detox | Cost based payment | |
| Utah | Yes | A & B - See state-specific FN | Ambulatory detox services not covered | Fee for service or capitated payment | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Limits vary by service | Yes | Fee for service |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $825 | Fee for service | ||
| Wyoming | Yes | CN | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 52 No - 4 | Yes - 12 No - 40 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Residential substance abuse treatment services covered in state-certified facilities only, services in residential psych treatment centers and day treatment services not covered | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Coverage limitations vary by service | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid daily rate |
| Colorado | Yes | CN | $2/visit | Outpatient substance abuse therapy limited to 25 individual sessions/year and 36 group therapy sessions/year; drug screening and monitoring limited to 36 specimens/year | Fee for service or prospective cost based rate | |
| Connecticut | Yes | CN & MN | 10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment | Prospective per diem or global rate | ||
| Delaware | Yes | CN | 30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Rehab centers must be state-approved | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Quantity and frequency limits vary by service | Capitated payment or fee for service | |
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Yes | Fee for service or prospective payment system rate | ||
| Idaho | Yes | CN | Psychosocial rehab 5 hours/week, substance abuse therapy 12 individual sessions/ week and 24 group sessions/week | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Yes | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Specified substance abuse services | Capitated payment or fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | Services for substance abuse as a primary diagnosis limited to pregnant women | Prospective cost based per diem | ||
| Louisiana | Yes | CN & MN | Substance abuse treatment not covered | Yes | Fee for service, some services paid monthly rate | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Substance abuse services limited to 30 weeks | Fee for service or negotiated rate | |
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service | |
| Massachusetts | Yes | CN & MN | Fee for service or negotiated rate | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Mental health service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Limited to therapies and medication related services only | Fee for service | ||
| Missouri | Yes | CN | Services limited to the severely mentally ill | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | Fee for service | |||
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Community mental health care limited to $1,800/year unless specified criteria met, low service utilizer with severe or persistent mental illness limited to $4,000/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | A - authorization required after 7 visits | Fee for service | |
| New York | Yes | CN & MN | Beneficiary Specific Utilization Thresholds apply to mental health services - see state-specific FN | Fee for service | ||
| North Carolina | Yes | CN & MN | Fee for service using quarter hour or hourly rates | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN | Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | 16 units/day for peer support up to 3,600 units/year, mobile mental health treatment limits vary by service or procedure | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | Negotiated rate | |||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | 5% of payment for mental health services | Substance abuse services limited to pregnant women | Prospective cost based rate | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/MH Clinic visit B2 - $10/MH Clinic visit | See state-specific FN | ||
| Texas | Yes | CN & MN | 135 hours for group substance abuse services or 26 hours for individual services; 35 days for residential treatment; 21 days for detox | Residential detox and treatment and ambulatory detox | Cost based payment | |
| Utah | Yes | A & B - See state-specific FN | Ambulatory detox services not covered | Capitated payment | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Limits vary by service | Yes | Fee for service |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $825 | Fee for service | ||
| Wyoming | Yes | CN | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 10 No - 41 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Residential substance abuse treatment services covered in state-certified facilities only, services in residential psychiatric treatment centers and day treatment services not covered | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Residential habilitation treatment covered only for developmentally disabled, substance abuse treatment providers must be state-approved | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid fee for service or negotiated rate |
| Colorado | Yes | CN | Rehab centers must be state-approved | Fee for service or prospective cost based rate | ||
| Connecticut | Yes | CN & MN | 10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment | Prospective per diem or global rate | ||
| Delaware | Yes | CN | 30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Rehab centers must be state-approved | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Quantity and frequency limits vary by service | Capitated payment or fee for service | |
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Yes | Fee for service or prospective payment system rate | ||
| Idaho | Yes | CN | Psychosocial rehab 10 hours/week, substance abuse therapy 12 individual sessions/ week and 24 group sessions/week | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Yes | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Specified substance abuse services | Capitated payment or fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | Adult coverage of substance abuse services as a primary diagnosis limited to pregnant women; covered as secondary diagnosis for other adults | Prospective cost based per diem | ||
| Louisiana | Yes | CN & MN | Substance abuse treatment not covered | Yes | Fee for service, some services paid monthly rate | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Substance abuse services limited to 30 weeks | Fee for service or negotiated rate | |
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service for mental health care, cost based payment for substance abuse treatment in most settings | |
| Massachusetts | Yes | CN & MN | Fee for service or negotiated rate | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Mental health service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Limited to therapies and medication related services only | Fee for service | ||
| Missouri | Yes | CN | Services limited to the severely mentally ill | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | Fee for service | |||
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Community mental health care limited to $1,800/year unless specified criteria met, low service utilizer with severe or persistent mental illness limited to $4,000/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Fee for service | ||
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | Fee for service using quarter hour or hourly rates | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN | Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Fee for service or capitated payment | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services not covered | Negotiated rate | ||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | 5% of payment for mental health services | Substance abuse services limited to pregnant women | Prospective cost based rate | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit | |||
| Texas | Yes | CN & MN | Limited to persons with severe or persistent mental health disorders | Cost based payment | ||
| Utah | Yes | A & B - See state-specific FN | Ambulatory detox services not covered | Capitated payment | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Limits vary by service | Fee for service | |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | B &C | B - 20 visits/year | Specified procedures | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $500 | Substance abuse services limited to 15 hours or $500/year, in-home services not covered for adults | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 50 No - 6 | Yes - 10 No - 40 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Residential substance abuse treatment services covered in state-certified facilities only, services in residential psychiatric treatment centers and day treatment services not covered | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Residential habilitation treatment covered only for developmentally disabled, substance abuse treatment providers must be state-approved | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid fee for service or negotiated rate |
| Colorado | Yes | CN | Rehab centers must be state-approved | Fee for service or prospective cost based rate | ||
| Connecticut | Yes | CN & MN | 10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment | Prospective per diem or global rate | ||
| Delaware | Yes | CN | 30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Rehab centers must be state-approved | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Capitated payment or fee for service | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Quantity and frequency limits vary by service | Yes | Fee for service or capitated payment based on reported encounters | |
| Idaho | Yes | CN | Psych service visit limits dependent on type of therapy, substance abuse treatment not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Specified services | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Services limited to substance abuse treatment and 3 treatment episodes/lifetime | Specified substance abuse services | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | Adult coverage of substance abuse services as a primary diagnosis limited to pregnant women; covered as secondary diagnosis for other adults | Prospective cost based rate per service | ||
| Louisiana | Yes | CN & MN | Substance abuse treatment not covered | Yes | Fee for service, some services paid monthly rate | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Substance abuse services limited to 30 weeks | Fee for service or negotiated rate | |
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service for mental health care, cost based payment for substance abuse treatment in most settings | |
| Massachusetts | Yes | CN & MN | Fee for service or negotiated rate | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Mental health service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Limited to therapies and medication related services only | Fee for service | ||
| Missouri | Yes | CN | Services limited to the severely mentally ill | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | Substance abuse treatment not covered | Fee for service | ||
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Mental health care limited to $1,800/year except limit for developmentally disabled or severely mentally ill is $12,000/year, substance abuse treatment not covered | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Fee for service | ||
| New York | Yes | CN & MN | 40 mental health visits/year | Fee for service | ||
| North Carolina | Yes | CN & MN | Fee for service using hourly rates | |||
| North Dakota | Yes | CN & MN | Fee for Service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN | Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Fee for service or capitated payment | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services not covered | Negotiated rate | ||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | 5% of payment for mental health services | Substance abuse services limited to pregnant women | Prospective cost based rate | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit | 10 days detoxification treatment/lifetime with $30,000 limit/lifetime on inpatient and outpatient drug and alcohol treatment | ||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | Ambulatory detox services not covered | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Day treatment limited to 780 time units/year, in-home care and residential treatment not covered for adults | Fee for service | |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | CN & MN | Specified procedures | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $500 | Substance abuse services limited to 15 hours or $500/year, in-home services not covered for adults | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 50 No - 6 | Yes - 9 No - 41 | ||||
| Alabama | Yes | CN & MN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Residential habilitation treatment covered only for developmentally disabled, substance abuse treatment providers must be state-approved | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid fee for service or negotiated rate |
| Colorado | Yes | CN | Rehab centers must be state-approved, substance abuse services limited to pregnant women | Fee for service or prospective cost based rate | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Rehab centers must be state-approved | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Fee for service | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Quantity and frequency limits vary by service | Yes | Fee for service or capitated payment based on reported encounters | |
| Idaho | Yes | CN | Psych service visit limits dependent on type of therapy, substance abuse treatment not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Specified services | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Services limited to substance abuse treatment and 3 treatment episodes/lifetime | Specified substance abuse services | Fee for service | |
| Kentucky | Yes | CN & MN | Prospective cost based rate per service | |||
| Louisiana | Yes | CN & MN | Substance abuse treatment not covered | Yes | Fee for service, some services paid monthly rate | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Fee for service or negotiated rate | ||
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service for mental health care, cost based payment for substance abuse treatment in most settings | |
| Massachusetts | Yes | CN & MN | Fee for service or negotiated rate | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Limited to therapies and medication related services only | Fee for service | ||
| Missouri | Yes | CN | Services limited to the severely mentally ill | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | Substance abuse treatment not covered | Fee for service | ||
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Mental health care limited to $1,800/year except limit for developmentally disabled or severely mentally ill is $12,000/year, substance abuse treatment not covered | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Fee for service | ||
| New York | Yes | CN & MN | 40 mental health visits/year | Fee for service | ||
| North Carolina | Yes | CN & MN | Fee for service using hourly rates | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN | Service limits vary by type of treatment, outpatient behavioral health services not covered for nursing facility residents | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | Yes | CN & MN | Fee for service | |||
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Cost based payment | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services not covered | Negotiated rate | ||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | Prospective cost based rate | |||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit | |||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | Ambulatory detox services not covered | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Day treatment limited to 780 time units/year, in-home care and residential treatment not covered for adults | Fee for service | |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | CN & MN | Specified procedures | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, copayment for psychotherapy limited to 15 hours or $500 | Substance abuse services limited to 15 hours or $500/year, in-home services not covered for adults | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 49 No - 7 | Yes - 9 No - 40 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | Substance abuse services require mental health primary diagnosis | Specified services | Fee for service | |
| California | Yes | CN & MN | $1/visit | Residential habilitation treatment covered only for developmentally disabled, substance abuse treatment providers must be state-approved | Specified services | Residential treatment facilities paid standard per diem by facility bed size, substance abuse services paid fee for service or negotiated rate |
| Colorado | Yes | CN | Rehab centers must be state-approved, substance abuse services limited to pregnant women | Fee for service or prospective cost based rate | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Approved treatment includes minimum of 1 hour/week face-to-face clinical contact | Fee for service or prospective cost based rate | ||
| District of Columbia | Yes | CN & MN | Rehab centers must be state-approved | Yes | Fee for service | |
| Florida | Yes | CN & MN | $2/day | Fee for service | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | No | |||||
| Idaho | Yes | CN | Psych service visit limits dependent on type of therapy, substance abuse treatment not covered | Fee for service | ||
| Illinois | Yes | CN & MN | Residential-based services, active community treatment | Fee for service, cost based per diem or certified cost | ||
| Indiana | Yes | CN | Specified services | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | Limited to services for treatment of chronic mental illness | Initial care plan and at least annually thereafter | Fee for service |
| Kansas | Yes | CN & MN | Services limited to substance abuse treatment and 3 treatment episodes/lifetime | Specified substance abuse services | Fee for service | |
| Kentucky | Yes | CN & MN | Prospective cost based rate per service | |||
| Louisiana | Yes | CN & MN | Substance abuse treatment not covered | Yes | Fee for service, some services paid monthly rate | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Fee for service or negotiated rate | ||
| Maryland | Yes | CN & MN | Mental Health service and visit limits vary based on medical need | Yes | Fee for service for mental health care, cost based payment for substance abuse treatment in most settings | |
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Capitation payment | |||
| Minnesota | Yes | A & B - See state-specific FN | Service and visit limits vary | Fee for service or negotiated rates | ||
| Mississippi | Yes | CN | Limited to therapies and medication related services only | Fee for service | ||
| Missouri | Yes | CN | Services limited to the severely mentally ill | Fee for service | ||
| Montana | Yes | CN & MN | Substance abuse treatment limited to state-approved facilities | Specified services | Fee for service | |
| Nebraska | Yes | CN & MN | Substance abuse treatment not covered | Fee for service | ||
| Nevada | Yes | CN | Rehab potential required | Fee for service | ||
| New Hampshire | Yes | CN & MN | Mental health care limited to $1,800/year except limit for developmentally disabled or severely mentally ill is $12,000/year, substance abuse treatment not covered | Fee for service | ||
| New Jersey | Yes | CN & MN | Fee for service | |||
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Fee for service | ||
| New York | Yes | CN & MN | 40 mental health visits/year | Fee for service | ||
| North Carolina | Yes | CN & MN | More than 8 outpatient psychiatric visits | Fee for service using hourly rates | ||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | Cost based payment | |||
| Oklahoma | Yes | CN & MN | Service limits vary by type of treatment | Fee for service or all-inclusive daily rate | ||
| Oregon | Yes | CN & MN | $3/visit | Specified procedures | Fee for service or negotiated rate | |
| Pennsylvania | Yes | CN & MN | Fee for service | |||
| Puerto Rico | Yes | CN & MN | Limited to services rendered by contracted staff | Cost based payment | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services not covered | Negotiated rate | ||
| South Carolina | Yes | CN | Centers must be state-approved | Fee for service | ||
| South Dakota | Yes | CN | Prospective cost based rate | |||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/MH Clinic visit, B2 - $10/MH Clinic visit | |||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state specific FN | Ambulatory detox services not covered | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | No | |||||
| Virginia | Yes | CN & MN | $3/visit | Day treatment limited to 780 time units/year, in-home care not covered for adults | Fee for service | |
| Washington | Yes | CN & MN | Ambulatory detox and other specified services not covered | Specified services | Fee for service or percentage of charge | |
| West Virginia | Yes | CN & MN | Specified procedures | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment | Substance abuse services limited to 15 hours or $500/year, in-home services not covered for adults | Fee for service | |
| Wyoming | Yes | CN | Fee for service |