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Medicaid B - Criterion 5

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Medicaid B

Diagnosis Group(s)

Developmental Disability, Mental Health, Substance Use

Age Group(s)

18-20, Child

Reference Documents


Submission Requirements

  • Service Authorization Request (SAR)

Service Definition Authorization Parameters

  • Initial and Concurrent: Up to 3 days

Calocus Level

1 2 3 4 5 6
Green check Green check

Service Codes & Descriptions

  • 902 - Psychiatric/Psychological Trt: Milieu therapy

Full Service Definition

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