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 (PDF) process as soon as possible.

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