MLN Product (Revised): Opioid Treatment Programs (OTPs) Medicare Billing & Payment
This revised Product comprises Subregulatory Guidance for OTPs Medicare billing & payment and its content is based on publically available content within at https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1751-f and https://www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center webpage. CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates on Medicare billing and payment for Opioid Use Disorder (OUD) treatment services. It has information about: covered OUD treatment services; who can supply OTP services; enrolling in Medicare Electronic Data Interchange (EDI); checking Medicare patient eligibility; coding and submitting claims for OTP services; payment and remittance advice (RA); issues with payment; how to check claims status; and helpful resources. Revisions to this Product include following content updates:
• added new HCPCS code G1028 - Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 mL nasal spray (pages 6-7)
• updated HCPCS code G2215 - Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 mL nasal spray (page 6)
• added Modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) to use on claim for counseling and therapy via audiovideo telecommunications using HCPCS code G2080 (pages 11 and 13)
• added Modifier FQ for audio-only counseling or therapy services (pages 11 and 13)
• updated Table 1: MAT Codes, Descriptors, & National Medicare Payment Rates to include updated rates, new HCPCS code G1028 and revised definition of HCPCS code G2215 (pages 7-10)
The previous version of this product is available to the public and currently posted on the CMS website at https://www.cms.gov/files/document/otp-billing-and-payment-fact-sheet.pdf.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 01, 2021
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.