Substance Use Disorder (SUD) Withdrawal Management Services

Revised: April 11, 2025

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Documentation of Covered Services

· Billing

· Utilization Management

· Legal References

Overview

Withdrawal management services are designed to assist patients in safely withdrawing from alcohol or other substances. American Society of Addiction Medicine (ASAM) defines multiple levels of care for withdrawal management. The following two ASAM-based residential levels of care for withdrawal management are included in the state’s Medicaid benefit set:

Level 3.2 Clinically Managed Program is defined as a residential setting with a medical director and a licensed practical nurse (LPN) on staff. An LPN must be on site 24 hours a day, seven days a week. A qualified medical professional must be available by telephone or in person for consultation 24 hours a day. Patients admitted to this level of care receive medical observation, evaluation, stabilization treatment services, a comprehensive assessment according to Minnesota Statutes, 245G.05 and access to medications administered by licensed staff trained to manage withdrawal.

Level 3.7 Medically Monitored Program is defined as a residential setting with a registered nurse (RN) and a medical director on staff. A registered nurse must be on site 24 hours a day and a qualified medical professional must be available every day. Patients must be able to see a qualified medical professional within 24 hours if needed. Patients admitted to this level of care receive medical observation, evaluation, stabilization treatment services, a comprehensive assessment according to Minnesota Statutes 245G.05 and access to medications administered by licensed staff trained to manage withdrawal.

Eligible Providers

To provide, bill and receive payment for withdrawal management services a provider must:

· Be a licensed 245F withdrawal management program or applicable tribal license.

· Be enrolled as a Minnesota Health Care Programs (MHCP) provider for withdrawal management services.

· Complete ASAM certification for the ASAM level(s) of care provided. Refer to information under the ASAM Certification heading in the SUD Services section of the MHCP Provider Manual.

· Enroll and participate in the Drug and Alcohol Abuse Normative Evaluation System (DAANES). All withdrawal management patients regardless of funding need to be entered into DAANES for each admission episode. Email DHS.DAANES@state.mn.us to obtain the necessary training and documents required to participate in DAANES after your enrollment with MHCP is complete.

Eligible Members

To access withdrawal management services, a patient may be on fee for service (MA), enrolled in a managed care organization (MCO), have private insurance or may be eligible for services through the Behavioral Health Fund (BHF) if they meet eligibility requirements. BHF financial eligibility is determined after services have been initiated.

Individuals enrolled with an MHCP-contracted MCO must contact their MCO for details on coverage and accessing SUD services.

Individuals seeking eligibility for services through BHF must complete the Behavioral Health Fund Request (DHS-2780A) (PDF) and submit the application to the individual’s county of financial responsibility as defined in Minnesota Statutes, 256B.02, subdivision 4.

Covered Services

Providers are responsible to know and understand the rules and regulations of any services they submit for reimbursement. Refer to the Substance Use Disorder Service Rate Grid with Dollar Amounts (DHS-7612) (PDF) for withdrawal management covered services.

The following Clinically Managed (Level 3.2) covered services are included in the per diem rate:

· Individual or group motivational counseling sessions

· Individual advocacy and case management services

· Care coordination

· Peer recovery support services

· Patient education

· Referrals to mutual aid, self-help and support groups

· An initial health assessment conducted by a nurse upon admission

· Daily on-site medical evaluation by a nurse

· Comprehensive assessment

· Stabilization planning

· Standardized collection tool for collecting health-related information

The following Medically Monitored (Level 3.7) covered services are included in the per diem rate:

· An initial health assessment conducted by a registered nurse upon admission

· Medical evaluation and consultation with a registered nurse 24 hours a day

· Availability of a licensed practitioner by telephone or in person for consultation 24 hours a day

· Ability to be seen within 24 hours or sooner by a licensed practitioner

· Availability of on-site monitoring of patient care seven days per week by a licensed practitioner

· Administer medications according to prescriber-approved orders

· Individual or group motivational counseling sessions

· Individual advocacy and case management services

· Care coordination

· Peer recovery support services

· Stabilization planning

· Comprehensive assessment

· Daily on-site medical evaluation by a nurse

· Referrals to mutual aid, self-help and support group

· Standardized collection tool for collecting health-related information

Noncovered Services

The following are not covered services:

· Comprehensive assessments

· Room-and-board services not clinically or medically necessary

· Services delivered to MHCP members managed by an MCO, with the exception of room-and-board services billed directly to DHS and without a service agreement

· Additional SUD treatment services or complexities added to the per diem rate

· Detoxification services

· Substance Use Disorder Medications for Opioid Use Disorder (SUD-MOUD) guest dosing

Services bundled in withdrawal management treatment and cannot be billed separately under substance use disorder services:

· Comprehensive assessment

· Treatment coordination

· Peer support services

· SUD-MOUD services, including SUD-MOUD - methadone, SUD-MOUD - other, SUD-MOUD - methadone-plus and SUD-MOUD - other-plus

Documentation of Covered Services

Progress notes must be entered in the patient’s file at least daily and immediately following any significant event. A progress note must be legible, signed and dated by the staff person completing the note. Each progress note must include:

· Patient involvement in stabilization planning, including type and amount of service

· Date of service

· Monitoring and observations of the patient’s medical needs

· Documentation of referrals made to other services or agencies

· Specification of the participation of others

Billing

Bill MHCP for only the following services when approved for behavioral health fund:

· Withdrawal Management Clinically Managed level 3.2

· Withdrawal Management Medically Monitored level 3.7

· Per diem rates includes room and board

For withdrawal management room-and-board services, bill the following:

· Value code 80 and the number of inpatient covered days

· Enter Value Code 24 with correct five-digit rate code from the Residential Value Codes for Billing Direct Access list corresponding to the listed service combinations.

Refer to the MHCP MN–ITS User Manual for instructions on how to submit electronic claims.

Interim Billing

Bill withdrawal management services that span multiple months using interim billing method. Include the date of discharge on the final treatment claim along with appropriate patient status code.

Type of Bill frequency (three-digit) codes:

· xx1 – Admit through discharge claim

· xx2 – Interim-first claim (first claim in a series of continuous claims or interim billing)

· xx3 – Interim-continuing claim

· xx4 – Interim-last claim (discharge claim)

· xx7 – Replacement of prior claim

· xx8 – Void/cancel of prior claim

Billing codes

Service Description	Unit	Revenue Code	Claim format	Type of bill	Service Limitations
Withdrawal Management Clinically Managed level 3.2	Day	0900	837I	86X	Per diem
Withdrawal Management Medially Monitored level 3.7	Day	0919	837I	86X	Per diem
Room and Board Associated with Withdrawal Management	Day	1002	837I	86X	Per diem

Medicare

Medicare does not cover withdrawal management. Certified Medicare facilities serving Medicare-eligible clients must follow the MHCP Medicare policy found in the MHCP Provider Manual; refer to Medicare and Other Insurance under Billing Policy.

Third-Party Liability (TPL)

Individuals with private insurance may qualify for behavioral health fund if their insurance does not cover 100 percent of their treatment. MHCP TPL policy applies to all SUD treatment providers, including withdrawal management providers. When a member has private commercial insurance, you must first bill the private commercial insurance before billing MHCP. Bill doing the following:

· Verify member eligibility in MN–ITS before submitting bills to MHCP. If MN–ITS indicates that TPL exists for the dates that you would like to bill for, then you must first bill the third party displayed in MN–ITS for the dates. If you bill MHCP for dates of service when TPL exists, MHCP will deny the claim.

· Submit appropriate documentation to MHCP after billing the TPL. You must follow the MHCP TPL policy found in the Medicare and Other Insurance section of the MHCP Provider Manual under Billing Policy.

Utilization Management

Providers are subject to participation in utilization reviews as defined in Minnesota Statutes, 256B.04, subdivision 15, and 254A.03, subdivision 3, paragraph b. Procedures are included on the medical review agent's webpage.

Legal References

Minnesota Statutes, 245F (Withdrawal Management Programs)
Minnesota Statutes, 254A.03 (Alcohol and Drug Abuse)
Minnesota Statutes, 254B (Substance Use Disorder Treatment)
Minnesota Statutes, 256B.031 (Prepaid Health Plans)
Minnesota Statutes, 256L (MinnesotaCare)
Code of Federal Regulations, title 42, section 440.130(d)