CMS Pub. 100-03, ch. 1, § 130.5

CIM 35-22.3

Coverage is available for alcoholism or drug abuse treatment services (such as drug therapy, psychotherapy,

and patient education) that are provided incident to a physicians 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. (See the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical

and Other Health Services,” §60.1; the Medicare Claims Processing Manual, Chapter 12,

“Physician/Practitioners Billing,” §10; the Medicare General Information, Eligibility, and Entitlement

Manual, Chapter 3, “Deductibles, Coinsurance Amounts, and Payment Limitations,” §30. 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 (see the Medicare General Information, Eligibility, and

Entitlement Manual, Chapter 3, “Deductibles, Coinsurance Amounts, and Payment Limitations,” §30) would

apply to alcoholism or drug abuse treatment services furnished by physicians to individuals who are not

hospital inpatients.