This regulation establishes Medicaid reimbursement rates for a broad range of substance abuse services billed under specific procedure codes in the District of Columbia. Covered services include detoxification (outpatient and residential), intensive outpatient treatment, residential treatment, methadone dosing, medication-assisted therapy, case management, counseling, diagnostic assessments, and various recovery support services. Facility operators must bill using the specified service codes and may only claim the listed per-unit rates for each service type.
View official source6201 REIMBURSEMENT RATE 6201.1 Reimbursement for substance abuse services shall be as follows: SERVICE CODE RATE per UNIT Urinalysis (Laboratory) H0003 15.00 Breathalyzer Collection H0048 8.80 Urinalysis Collection H0048 LR 8.80 Case Management H0006 20.02 Case Management (HIV) H0006V9 20.02 Treatment Planning T1007 22.00 Treatment Planning - Complex IP T1007TG 24.00 Targeted Case Management (Clinical Care Coordination) T1017HF 22.50 Counseling Group H0005 10.45 Counseling Group - Psycho-educational H2027 3.51 Counseling Group - Psycho-educational (HIV) H2027V9 3.51 Counseling On-site - Behavioral Health Therapy H0004 26.42 Counseling, Off-site H0004HFTN 27.45 Counseling, Family with Client H0004HR 26.42 Counseling, Family without Client H0004HS 26.42 Crisis Intervention H0007HF 36.93 CS Peer Support Group - Substance Abuse H0038HFHQ 6.65 CS Peer Support - Substance Abuse H0038HF 21.97 Detoxification - Outpatient - Ambulatory H0014 24.53 Detoxification - Residential - Acute care H0010 605.00 Behavioral Health Screening - Determine eligibility H0002HF 85.34 Behavioral Health Screening - Evaluate Risk Rating H0002TG 140.00 Diagnostic Assessment – In-depth - Adult H0001HF 256.02 Diagnostic Assessment - Ongoing - Modify Tx Plan H0001TS 85.34 Diagnostic Assessment - In-depth Exam - Youth H0001HA 256.02 Diagnostic Assessment - Ongoing Follow-up - Youth H0001HATS 85.34 Intensive Outpatient - All Inclusive H0015 74.25 Intervention - Substance Abuse Recognition H0022 27.17 Dose - Methadone - Clinic or Take-Home H0020 8.58 Medication Assisted Therapy H0020HF 8.58 Medication Management - Adult H0016HF 44.65 Medication Management - Youth H0016HAHF 44.65 Multisystemic Therapy for Juveniles (ACRA) (ages 21 – 24) H2033HF 57.42 Multisystemic Therapy for Juveniles (ACRA) (ages 12 – 20) H2033HAHF 57.42 Outpatient Therapy - Intensive H0015HA 164.61 Prenatal Care, at-risk Assessment H1000 142.56 Prenatal Care, at-risk enhanced service - Ante-partum Management H1001 80.08 Prenatal Care, at-risk enhanced service - Care Coordination H1002 80.08 Prenatal Care, at-risk enhanced service - Education H1003 80.08 Prenatal Care, at-risk enhanced service - follow-up Home Visit H1004 100.76 Residential - Long term Therapeutic H0019 132.55 Residential - Long term Room & Board H0043 72.90 Residential – Youth Room and Board H0043HA 167.40 Residential Treatment - Inclusive H0018 136.84 Residential Treatment – Inclusive (Youth) H0018HA 197.60 Residential Treatment – Inclusive (HIV) H0018V9 136.84 Residential Per Diem - Women w/1 child H0043UN 210.00 Residential Per Diem - Women w/2 children H0043UP 215.00 Residential Per Diem - Women w/3 children H0043UQ 220.00 Residential Per Diem - Women w/4 or more children H0043UR 225.00 2010 Recovery Support Evaluation 2010 85.00 2090 Family and Marital Services - Individual 2090 140.00 2091 Family and Marital Services - Group 2091 50.00 3010 Parenting Services – Individual 3010 90.00 3011 Parenting Services – Group 3011 50.00 3020 Child Care (1 – 2 Children) 3020 15.00 3021 Child Care (3 or more children) 3021 30.00 3040 Care Coordination 3040 35.00 3051 Transportation (Public) 3051 65.00 4050 Environmental Stability – Individual 4050 212.25 4051 Environmental Stability – Women w/children 4051 250.00 5030 Recovery Mentoring/Coaching 5030 75.00 5040 Life Skills – Individual 5040 45.00 5041 Life Skills (Group Adult) 5041 25.00 5041 Life Skills (Group – Youth) 5041 50.00 5050 Spiritual Support Group 5050 50.00 6020 HIV/AIDS Education 6020 25.00 6030 Education Services – Individual 6030 75.00 6031 Education Services – Group 6031 50.00 SOURCE: Final Rulemaking published at 61 DCR 3548 (April 4, 2014); as amended by Final Rulemaking published at 62 DCR 3017 (March 13, 2015). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 6201