LCD/NCD Portal

NCD130.5

 

TREATMENT OF ALCOHOLISM AND DRUG ABUSE IN A FREESTANDING CLINIC

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Incident to a physician's professional Service.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Indications and Limitations of Coverage

• Coverage is available for alcoholism or drug abuse treatment services (such as drug therapy, psychotherapy, and patient education) that are provided incident to a physician's professional service in a freestanding clinic to patients who, for example, have been discharged from an inpatient hospital stay for the treatment of alcoholism or drug abuse or to individuals who are not in the acute stages of alcoholism or drug abuse but require treatment.

• The coverage available for these services is subject to the same rules generally applicable to the coverage of clinic services.

• Of course, the services also must be reasonable and necessary for the diagnosis or treatment of the individual's alcoholism or drug abuse.

• The Part B psychiatric limitation would apply to alcoholism or drug abuse treatment services furnished by physicians to individuals who are not hospital inpatients.

 

Cross Reference

• See the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 3 §30, Medicare Claims Processing Manual, Chapter 12 §10, and Medicare Benefit Policy Manual, Chapter 15 §60.1.

 

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