Provider Alert! Update: Substance Use Disorder (SUD) Service Code H0050 now requires a Prior Authorization and Authorization Reminders

Attention: Behavioral Health Providers   

Effective Date: September 23, 2020 for Code H0050

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Withdrawal Management Services. Effective September 23, 2020, Substance Use Disorder (SUD) Code, H0050 requires a Prior Authorization.

How this impacts providers:

Prior Authorization reminder for the following Codes:

• Outpatient Withdrawal Management Treatment Services
  • H0012 – Alcohol and/or drug services; subacute detoxification (residential addiction program outpatient)
  • H0016 – Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)
  • H0031 – Mental health assessment, by non-physician
• Prior Authorization required only when these Outpatient Treatment Service Codes exceed the benefit limit
  • H0004 – Behavioral health counseling and therapy, per 15 minutes
  • H0005 – Alcohol and/or drug services; group counseling by a clinician
    • Limit for these codes are 135 units of group counseling and 26 hours of individual counseling per calendar year when provided by Chemical Dependency Treatment Facility (CDTF).
  • Residential Treatment Services
    • H2035 – Alcohol and/or other drug treatment program, per hour

Prior authorization is not required for the following SUD Codes. For reimbursement, it is age restricted to twenty-one (21) years old and older:

• S9445-treatment plan
• T1007-treatment plan development
• H0047- alcohol and/or other drug abuse services, not otherwise specified

Next steps for providers: Providers should communicate the new prior authorization requirement for Code H0050 to their staff.

Reference: Prior authorization form

Behavioral Health Services Fax Line – 832-825-8767 or Toll-Free 1-844-291-7505

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.