Outpatient Hospital Services for Treatment of Alcoholism

CMS National Coverage Determination | ncd_id=27 | manual_section=130.2 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

Coverage is available for both diagnostic and therapeutic services furnished for the treatment of alcoholism by the hospital to outpatients subject to the same rules applicable to outpatient hospital services in general. While there is no coverage for day hospitalization programs, per se, individual services which meet the requirements in the Medicare Benefit Policy Manual , Chapter 6, §20 may be covered. (Meals, transportation and recreational and social activities do not fall within the scope of covered outpatient hospital services under Medicare.) All services must be reasonable and necessary for diagnosis or treatment of the patient's condition (see the Medicare Benefit Policy Manual , Chapter 16 §20). Thus, educational services and family counseling would only be covered where they are directly related to treatment of the patient's condition. The frequency of treatment and period of time over which it occurs must also be reasonable and necessary.

Item/Service Description: Some hospitals also provide services on an outpatient basis, either individually or as part of a day hospitalization program, for treatment of alcoholism. These services may include, for example, drug therapy, psychotherapy, and patient education and may be furnished by physicians, psychologists, nurses, and alcoholism counselors to individuals who have been discharged from an inpatient hospital stay for treatment of alcoholism and require continued treatment or to individuals from the community who require treatment but do not require the inpatient hospital setting. Cross Reference: See the NCD Manual § 70.1 . Benefit Categories: 46 - Outpatient Hospital Services Incident to a Physician's Service