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Benefit Plan Service Details

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Coverage:Medicaid B Coverage:Medicaid C Coverage:Medicaid FFS Coverage:Medicaid TBI Coverage:State Coverage:All Coverage
Diagnosis Group:All Diagnosis Group:Mental Health Diagnosis Group:Substance Use Diagnosis Group:Developmental Disability Diagnosis Group:Assessment Only Diagnosis Group:All Diagnosis Group
Age Range:All Age Range:Adult Age Range:Child Age Range:18 Age Range:18-20 Age Range:All Age Range
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Medicaid B

Last updated 06-08-2022

Medicaid B - Ambulatory Detoxification

Coverage:Medicaid B

Diagnosis Group:Substance Use, Assessment Only

Age Range:Adult, 18-20

Medicaid B

Last updated 02-28-2022

Medicaid B - Assertive Community Treatment Team (ACTT)

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use

Age Range:18-20, Adult, Child

Medicaid B

Last updated 09-30-2022

Medicaid B - Child and Adolescent Day Treatment

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use, Developmental Disability

Age Range:Child, 18-20

Medicaid B

Last updated 09-02-2022

Medicaid B - Clinical/Diagnostic Assessment and Comprehensive Evaluation of Sexual Harm (CESH)

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use, Developmental Disability, Assessment Only

Age Range:All, Adult, Child, 18, 18-20

Medicaid B

Last updated 08-23-2022

Medicaid B - Community Support Team (CST)

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use, Developmental Disability

Age Range:Adult, Child, 18-20

Medicaid B

Last updated 08-23-2022

Medicaid B - Comprehensive Trauma Informed Assessment (90791 TI)

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use, Developmental Disability

Age Range:Child, 18-20

Medicaid B

Last updated 02-28-2022

Medicaid B - Criterion 5

Coverage:Medicaid B

Diagnosis Group:Developmental Disability, Mental Health, Substance Use

Age Range:18-20, Child

Medicaid B

Last updated 02-28-2022

Medicaid B - Developmental Testing (Extended)

Coverage:Medicaid B

Diagnosis Group:Developmental Disability, Mental Health, Substance Use

Age Range:18-20, Adult, All, Child

Medicaid B

Last updated 02-28-2022

Medicaid B - Dialectical Behavior Therapy (DBT)

Coverage:Medicaid B

Diagnosis Group:Mental Health, Substance Use

Age Range:18-20, Adult, Child

Medicaid B

Last updated 02-28-2022

Medicaid B - Evaluation and Management (E and M) and Medication Assisted Treatment (MAT)

Coverage:Medicaid B

Diagnosis Group:All, Assessment Only, Developmental Disability, Mental Health, Substance Use

Age Range:18, 18-20, Adult, All, Child