Substance Use Disorder Treatment
Substance use disorder treatment in the following circumstances may be a covered benefit:
- Acute inpatient care: Treatment for complications of alcohol and drug abuse or dependency and detoxification is covered only when the patient's condition is such that a hospital setting is required. Prior authorization is not required for emergency admissions, however, Health Net Federal Services, LLC requires notification of inpatient facility admissions and discharge dates by the next business day following the admission and discharge.
- Rehabilitation: Prior authorization is required for all beneficiaries when receiving care in an inpatient facility.
- Outpatient services: Individual, group and family therapy is covered by an individual provider or in a partial hospitalization program/intensive outpatient program, or a substance use disorder rehabilitation facility. See psychotherapy, partial hospitalization programs or intensive outpatient programs for additional information.
Visit our Substance Use Disorder Rehabilitation Facility (SUDRF) Billing Tips page for inpatient and rehabilitation claims information.