Opioid Treatment Programs

Opioid Treatment Programs (OTPs) provide medications for opioid use disorder (MOUD). OTPs must be certified by SAMHSA and accredited by an independent, SAMHSA-approved accrediting body.

We pay OTPs through bundled payments for OUD treatment services for Medicare Part B patients. 

Under the OTP benefit, Medicare covers:

• U.S. FDA-approved opioid agonist and antagonist MOUD medications
• Dispensing and administering MOUD medications, if applicable
• Substance use counseling
• Individual and group therapy
• Toxicology testing
• Intake activities
• Periodic assessments
• Assessments as part of intake activities and periodic assessments
• Intensive outpatient program services
• Coordinated care and referral services
• Patient navigational services
• Peer recovery support services

Part B covers many services that help people with Medicare continue treatment for OUD for as long as reasonable and necessary. For example, OTPs:

• Dispense and administer MOUD medications, including methadone, buprenorphine (oral, injectable, and implantable), naltrexone, naloxone, and nalmefene.
• Provide overdose education when they furnish take-home supplies of naloxone and nalmefene.
• Provide counseling and other behavioral health services, including substance use counseling, individual, and group therapy, which can be conducted via two-way audio-video communication.
• Provide toxicology testing, intake and periodic assessments, intensive outpatient programs, and peer recovery support services. People with Medicare may get these services furnished by mobile vans.

Medicare Advantage (MA) plan participants and dually eligible patients (those enrolled in both Medicare and Medicaid) get OTP services.