Issued: April 29, 2024

Beginning May 1, 2024, Partners Health Management will add several State-funded substance use withdrawal management services to its behavioral health benefit array.

What is happening?

Effective May 1, 2024, Partners will add the following State-funded substance use withdrawal management services to its behavioral health benefit array:

  • Ambulatory Withdrawal Management without Extended On-Site Monitoring
  • Ambulatory Withdrawal Management with Extended On-Site Monitoring
  • Clinically Managed Residential Withdrawal Management Services
  • Medically Monitored Inpatient Withdrawal Management.

The services, benefit limits, level of care and required documentation are described in the chart at the bottom of this document.

Where can providers find additional information?

For clinical information, providers can refer to the applicable State-funded Service Definition:

https://www.ncdhhs.gov/providers/provider-information/mental-health-development-disabilities-and-substance-use-services/service-definitions

Who should providers contact if they have additional questions?

Providers should email UMQuestions@PartnersBHM.org if they have questions.

 

State-funded Adult Behavioral Health Services
Service Description Benefit Limit Level of Care Source Documentation Required for Authorization
Ambulatory Withdrawal Management without Extended On-Site Monitoring:

H0014 – Ambulatory WM w/o Extended On-Site Monitoring

Ambulatory Detoxification ends 5/1/24.

Service Authorization Request (SAR) is not required.

 

1 unit = 15 minutes.

ASAM: Level 1-WM State Service Order is required and is due on or before the first date of service. Service Order is valid for one year. Service can be signed by a physician or physician extender.

Abbreviated Assessment, CCA or DA, Service Order, and Service Plan (with updates). CIWA-Ar score (or other comparable standardized scoring system).

Ambulatory Withdrawal Management with Extended On-Site Monitoring:

H0014 HF – Ambulatory WM w/ Extended On-Site Monitoring

 

 

Service Authorization Request (SAR) is not required.

 

1 unit = 15 minutes.

 

ASAM: Level 2-WM State Service Order is required and is due on or before the first date of service. Service Order is valid for one year. Service can be signed by a physician or physician extender.

Abbreviated Assessment, CCA or DA, Service Order, and Service Plan (with updates). CIWA-Ar score (or other comparable standardized scoring system).

Clinically Managed Residential Withdrawal Management Services:

H0011 – Clinical Managed Residential WM Services

Service Authorization Request (SAR) is not required.

 

1 unit = 1 Day

ASAM: Level 3.2- WM Service Order is required and is due on or before the first date of service. Service Order is valid for one year. Service can be signed by a physician or physician extender.

Abbreviated Assessment, CCA or DA, Service Order, Service Plan (with updates). CIWA-Ar score (or other comparable standardized scoring system).

Medically Monitored Inpatient Withdrawal Management Services:

H0010 – Medically Monitored Inpatient WM

Non-Hospital Medical Detoxification ends 5/1/24.

Service Authorization Request (SAR) is not required.

 

1 unit = 1 Day

ASAM: Level 3.7- WM Service Order is required and is due on or before the first date of service. Service Order is valid for one year. Service can be signed by a physician or physician extender.

Abbreviated Assessment, CCA or DA, Service Order, Service Plan (with updates). CIWA-Ar score (or other comparable standardized scoring system).