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Medicaid B - Ambulatory Detoxification

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Medicaid B

Diagnosis Group(s)

Substance Use, Assessment Only

Age Group(s)

Adult, 18-20

Reference Documents


Submission Requirements

  • Service Authorization Request (SAR)
  • Person Centered Plan (PCP) with Service Order

Service Definition Authorization Parameters

  • Initial: 7 days
  • Concurrent: 3 days
  • Maximum 10 days per episode

COVID Prior Approval Flexibility

  • Waive Prior Approval for Initial and Concurrent Requests

ASAM Level of Care


Service Codes & Descriptions

  • H0014 - Ambulatory Detoxification

Full Service Definition

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