Opioid Treatment Programs (OTP)

Reducing Opioid Misuse

Learn more about how CMS is fighting the opioid epidemic.

Opioid Treatment Programs (OTP)

Please Note: COVID-19: CMS Allowing Audio-Only Calls for OTP Therapy, Counseling, and Periodic Assessments  


Overview

As of January 1, 2020, CMS pays 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 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

 

New for CY 2022

  • After the end of the COVID-19 PHE, CMS will allow audio-only interaction (such as telephone calls) for counseling and therapy in cases where audio/video communication isn’t available to the patient, including circumstances in which the patient can’t or won’t agree to the use of two-way audio/video communication. OTPs must use a service-level modifier for audio-only services billed using the counseling and therapy add-on code.
  • CMS established a new code for a higher dose of naloxone hydrochloride nasal spray in response to the increase in overdoses from illicitly manufactured fentanyl, which can require a more potent overdose reversal drug.

 

We encourage OTPs to enroll in the Medicare program.

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

Page Last Modified:
03/31/2022 09:26 AM