Overview

Opioid Treatment Programs (OTP)

Starting January 1, 2020, under the Calendar Year (CY) 2020 Physician Fee Schedule final rule the Centers for Medicare & Medicaid Services (CMS) will pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B (Medical Insurance). 

Under the new OTP benefit, Medicare covers:

  • U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
  • Dispensing and administration of MAT medications (if applicable)
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments

We encourage OTPs to begin the enrollment process as soon as possible.

Read our Letter to OTP Program Sponsors and State Opioid Treatment Authorities (SOTAs) (PDF)  .

Page Last Modified:
11/04/2019 02:17 PM