Medicaid B: Facility Based Crisis (FBC)

• Clinical Coverage Policy 8A
• Clinical Coverage Policy 8A-2

Submission Requirements

Adult:

• S9484
• Clinical Coverage Policy 8A
• Service Authorization Request (SAR) required when beyond initial pass through

Child/Adolescent:

• S9484 HA
• Clinical Coverage Policy 8A-2
• Service Authorization Request (SAR) required to be submitted within 2 business days of admission

Service Definition Authorization Parameters

Adult:

• Authorization required after initial 7 days of service
• Initial: Up to 8 days

Child/Adolescent:

• Prior Authorization Required
• Initial and Concurrent: Up to 7 days
• Age 6-17 years