California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 7 - Payment for Services and Supplies › Section 51533 - Outpatient Heroin Detoxification Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Daily treatment of patients shall be
					 reimbursed in accordance with the schedule shown below:
Procedure Code
Per
								Visit Allowance
Z6600
(1) Services rendered during the
								first seven days, per visit Services shall include: taking of the initial
								history; physical examination by a physician; other physician services
								necessary to the heroin detoxification services; necessary urine screening
								tests and related specimen handling; daily visits to the clinic for medication
								or reexamination; any other procedures related to outpatient heroin
								detoxification
								services...........................
..........................$14.60
Z6602
(2) Services rendered from the 8th
								through the 21st day, per visit Services shall include administering medication
								and other procedures related to outpatient heroin detoxification
								services...........................
..........................$9.29
Z6604
(3) Reexamination by a physician
								between 8th and 21st days, maximum of one per week, per visit Reexamination by
								a physician shall be provided only as a substitute for visits under (a) (2) and
								payment shall include all other services specified under (a)
								(2)...........................
..........................$18.01
(b) Additional charges may be billed by
					 appropriately licensed facilities or by physicians or other Medi-Cal providers
					 for services medically necessary to diagnose and treat diseases which, in the
					 individual patient, the physician believes are concurrent with but not part of
					 the outpatient heroin detoxification services as defined in Section
					 51116. Fees for additional
					 physician services provided for the diagnosis and treatment of concurrent
					 diseases or illness shall be reduced to reflect any fees already paid in the
					 daily outpatient heroin detoxification service.
(c) A new course of outpatient heroin
					 detoxification treatment shall not be covered until at least 28 days have
					 elapsed since the completion of an immediately preceding course. New courses of
					 outpatient heroin detoxification treatment by the same provider which are
					 started in the period between the 29th and through the 90th days following the
					 completion of an immediately preceding course of treatment shall be reimbursed
					 at the rates listed under (a) (2) and (3). The daily rate listed under (a) (1)
					 shall not be billed by the same provider or separately billed by a physician
					 employee of that provider until 90 days have elapsed. The patient may be
					 considered a new patient for reimbursement purposes after 90 days following the
					 completion of the immediately preceding course of heroin
					 detoxification.
(d) The patient may
					 be considered a new patient for reimbursement purposes by a new provider for
					 heroin detoxification services started in the period between the 29th through
					 the 90th days following completion of an immediately preceding course of heroin
					 detoxification services only if the fact of the preceding course is denied or
					 misrepresented by the patient. Otherwise reimbursement shall be according to
					 Section (c).
1.
						Amendment of subsection (a) filed 8-1-84 as an emergency; effective upon filing
						(Register 84, No. 31.) A Certificate of Compliance must be transmitted to OAL
						within 120 days or emergency language will be repealed on 11-29-84. For prior
						history, see Register 81, No. 52.
2. Certificate of Compliance
						transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No.
						52).
3. Amendment of subsection (a) filed 8-1-85 as an emergency;
						effective upon filing (Register 85, No. 32). A Certificate of Compliance must
						be transmitted to OAL within 120 days or emergency language will be repealed on
						11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85
						and filed 12-27-85 (Register 85, No. 52).
5. Amendment of subsection
						(a) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A
						Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency
						language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 9-25-92 order transmitted to
						OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
7. Editorial
						correction of subsection (c) (Register 95, No.
						45).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14105,
						  Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items
						  4260-106-001 and 890; and Statutes of 1985, Chapter 111, Items 4260-106-001 and
						  890.