{"id":15542,"date":"2022-07-21T05:32:26","date_gmt":"2022-07-21T05:32:26","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15542"},"modified":"2025-09-12T07:07:59","modified_gmt":"2025-09-12T07:07:59","slug":"proposed-billing-guidelines-for-opioid-treatment-programs-otps","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/","title":{"rendered":"Proposed Billing Guidelines for Opioid Treatment Programs (OTPs)"},"content":{"rendered":"

Medicare Physician Fee Schedule Proposed Rule<\/span><\/h2>\n

CMS covers Opioid Treatment Programs through bundled payments for opioid use disorder treatment services in an episode of care provided to people with Medicare Part B. Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.\u00a0<\/span><\/p>\n

Revised Pricing for Drug Component of Methadone<\/span><\/h2>\n

In order to stabilize the price for methadone for CY 2023 and subsequent years, CMS is proposing to revise the methodology for pricing the drug component of the methadone weekly bundle and the add-on code for take-home supplies of methadone. Under this proposal, CMS would base the payment amount for the drug component of HCPCS codes G2067 and G2078 for CY 2023 and subsequent years on the payment amount for methadone in CY 2021 and update this amount annually to account for inflation using the PPI for Pharmaceuticals for Human Use (Prescription).<\/span><\/p>\n

Modifying Payment Rate for Non-Drug Component<\/span><\/h2>\n

Additionally, based on the severity of the needs of the patient population diagnosed with opioid use disorder (OUD) and receiving services in the OTP setting, CMS is proposing to modify the payment rate for the non-drug component of the bundled payments for episodes of care to base the rate for individual therapy on a crosswalk code describing a 45-minute session, rather than the current crosswalk to a code describing a 30-minute session. This would increase overall payments for medication-assisted treatment and other treatments for OUD, recognizing the longer therapy sessions that are usually required.<\/span><\/p>\n

Treatment with Buprenorphine<\/span><\/h2>\n

CMS is also proposing to allow the OTP intake add-on code to be furnished via two-way audio-video communications technology when billed for the initiation of treatment with buprenorphine, to the extent that the use of audio-video telecommunications technology to initiate treatment with buprenorphine is authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services<\/a> Administration (SAMHSA) at the time the service is furnished. CMS is also proposing to permit the use of audio-only communication technology to initiate treatment with buprenorphine in cases where audio-video technology is not available to the beneficiary and all other applicable requirements are met.\u00a0<\/span><\/p>\n

Additionally, CMS is clarifying that OTPs can bill Medicare for medically reasonable and necessary services furnished via mobile units in accordance with SAMHSA and DEA guidance. CMS is proposing that locality adjustments for services furnished via mobile units would be applied as if the service were furnished at the physical location of the Opioid Treatment Programs registered with DEA and certified by SAMHSA.<\/span><\/p>\n

You can refer CMS article <\/span>\u2018Medicare Physician Fee Schedule (MPFS) Proposed Rule CY 2023\u2019<\/span><\/a> for more information on proposed billing guidelines for OTPs. <\/span><\/p>\n

In case any assistance is needed for Behavioral Health medical billing and coding<\/a> for your practice, Contact <\/span>MedicalBillersandCoders (MBC)<\/b> at info@medicalbillersandcoders.com<\/a>\/ 888-357-3226<\/strong><\/a> for more information.<\/span><\/p>\n

FAQs<\/h2>\n\n\n
1. What is the Medicare Physician Fee Schedule (PFS)?<\/strong><\/strong>

The Medicare Physician Fee Schedule (PFS) outlines how Medicare payments are made to healthcare providers for services, including changes in policy and pricing for various treatments.<\/p> <\/div>

2. What changes are proposed for methadone pricing?<\/strong><\/strong>

CMS proposes to stabilize methadone pricing by revising how the drug component of the methadone weekly bundle is priced, using the 2021 payment amount as a baseline and adjusting it annually for inflation.<\/p> <\/div>

3. How will payments for non-drug components change?<\/strong><\/strong>

CMS plans to modify payment rates for the non-drug component of opioid treatment programs (OTPs) by basing individual therapy rates on a 45-minute session instead of a 30-minute session, acknowledging the need for longer therapy sessions.<\/p> <\/div>

4. What is the proposal regarding buprenorphine treatment?<\/strong><\/strong>

CMS proposes to allow the initiation of buprenorphine treatment via two-way audio-video communications and audio-only technology when video is not available, as long as it complies with DEA and SAMHSA guidelines.<\/p> <\/div>

5. Can mobile units bill Medicare for OTP services?<\/strong><\/strong>

Yes, CMS clarifies that OTPs can bill Medicare for necessary services provided through mobile units, applying locality adjustments as if the services were delivered at the OTP’s registered physical location.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"

Medicare Physician Fee Schedule Proposed Rule CMS covers Opioid Treatment Programs through bundled payments for opioid use disorder treatment services in an episode of care provided to people with Medicare Part B. Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes […]<\/p>\n","protected":false},"author":1,"featured_media":15543,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3545],"tags":[4459,3561,3227,806,3560,3002,3563,3204,4460,3562],"class_list":["post-15542","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-behavioral-health-billing","tag-behavioral-health-medical-billing-and-coding","tag-billing-guidelines-for-opioid-treatment-programs","tag-centers-for-medicare-medicaid-services-cms","tag-medicare-part-b","tag-medicare-physician-fee-schedule-proposed-rule","tag-mental-health-services","tag-opioid-treatment-programs","tag-physician-fee-schedule","tag-proposed-billing-guidelines-for-otps","tag-substance-abuse"],"yoast_head":"\nProposed Billing Guidelines for Opioid 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What is the Medicare Physician Fee Schedule (PFS)?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The Medicare Physician Fee Schedule (PFS) outlines how Medicare payments are made to healthcare providers for services, including changes in policy and pricing for various treatments.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660824098","position":2,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660824098","name":"2. What changes are proposed for methadone pricing?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CMS proposes to stabilize methadone pricing by revising how the drug component of the methadone weekly bundle is priced, using the 2021 payment amount as a baseline and adjusting it annually for inflation.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660834546","position":3,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660834546","name":"3. How will payments for non-drug components change?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CMS plans to modify payment rates for the non-drug component of opioid treatment programs (OTPs) by basing individual therapy rates on a 45-minute session instead of a 30-minute session, acknowledging the need for longer therapy sessions.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660844327","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660844327","name":"4. What is the proposal regarding buprenorphine treatment?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CMS proposes to allow the initiation of buprenorphine treatment via two-way audio-video communications and audio-only technology when video is not available, as long as it complies with DEA and SAMHSA guidelines.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660854372","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/proposed-billing-guidelines-for-opioid-treatment-programs-otps\/#faq-question-1757660854372","name":"5. 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