Physicians and other qualified practitioners will be reimbursed for substance use disorder (SUD) consultations in the inpatient hospital or emergency department setting effective Jan. 1, 2024. These services include assessment, evaluation, diagnosis and treatment of individuals during a medically indicated hospital encounter with a co-occurring SUD.
Services provided by non-physician practitioners such as physician assistants or advanced practice registered nurses must be performed in compliance with the terms of a collaborative or practice agreement with a physician, consistent with state scope of practice laws.
This service is separate and distinct from inpatient hospital detoxification services currently covered through Medicaid Fee-for-Service or residential treatment provided by a Prepaid Inpatient Health Plan. Prior authorization for these services is not required.
Please refer to MMP 23-49 for more information. Members with questions may contact Kelsey Ostergren with the MHA.