AOD Billable Services.xlsx

DRAFT: Substance Use Services Reimbursement Matrix
FY 2013/14 Rates*
Medi-Cal Eligible (Currently Eligible - Services/Rates Prior to January 1, 2014 ACA)
D/MC Coverage
PHC Coverage
Rate (DMC/ PHC)
Engage/Pre-Treatment Readiness
No
Assessment
Outpatient Treatment
No
Yes (6 sessions/ episode: 60-90
min)
NA/$40.00
Individual (50 minutes)
Yes (Generally Limited to Treatment
Planning, Discharge, Crisis)
Yes (20 sessions/rolling year)
Yes (Peri DMC is up to 60 days postpartum)
Yes (48 sessions/rolling year)
CMSP/Path2Health Eligible
Coverage
Un/Under-Insured (County AOD subsidized)
Rate
Coverage
Rate
Outreach, Engagement and Assessment
Peri Individual (50 minutes)
Group (90 minutes)
Peri Group (50 minutes)
IOP Group (3 hours)
Peri IOP Group (3 hours)
Residential Treatment
Residential
Peri Residential
No
Yes (Up to 60 days post-partum)
No
Yes (Up to 60 days postpartum/episode)
Medication Assisted Treatment
Methadone (Daily Dose)
Yes
Methadone (Ind. Couns.-10 min.)
Yes
Peri Methadone (Daily Dose)
Yes
Peri Methadone (Ind Coun.-10 min)
Yes
Detoxification
Detox: Short-Term Residential
No
Other: Continuous Recovery/Care Management/Family
$72.32/$50.00
No
NA
Varies by Contract
Varies by Contract
Yes (1 session/CY)
$90.00
RCC Only
$70.00/hour
$103.52/$50.00
$29.39/$35.00
$62.24/$35.00
NA/$66.00
Yes (2 sessions/
calendar year)
$17.50/15-minutes, up
to $70.00/60 minutes)
Yes
$70.00
Yes (20 sessions/
calendar year)
$30.00
Yes
$32.00
No
NA
Yes
$75.00
$79.39/$81.00
No
NA
Yes
$75.00
No
No
NA
Yes
$95.00
$97.72/$71.00
No
NA
Yes
$140.00
No
No
No
No
$11.49/NA
$14.46/NA
$12.57/NA
$20.70/NA
No
No
No
No
NA
NA
NA
NA
Yes
Yes
Yes
Yes
$5.21
$8.18
$5.21
$8.18
No
NA/NA
No
NA
Yes
$160.00
Yes (14 sessions/episode)
Yes (61 days post-partum or if
D/MC benefits are exhausted, up
to 14 sessions/episode)
No
Yes (61 days post-partum, up to
30 days/episode)
Continuous Recovery
No
Yes (up to 3- 60 to 90 minute
sessions/ week, up to 20
sessions/episode)
NA/$33.00
No
NA
No
NA
Care Management
No
No
NA/NA
No
NA
$55.00
No
Yes (1- 60 to 120 minute
session/week up to 4
sessions/episode; excludes
client participation)
RCC and Grant-Funded
Only
NA/$40.00
No
NA
No
NA
Family and Codependency
*Note: The Drug/Medi‐Cal rates are the proposed FY 2013/14 rates. The CMSP/Path2Health and PHC rates are from FY 2012 and updated rates will be provided when available.