Opioid Treatment Programs (OTP)

Reducing Opioid Misuse

Learn more about how CMS is fighting the opioid epidemic.

Materials from Recent MAC Calls

In December, the Medicare Administrative Contractors (MACs) hosted calls to introduce themselves and educate OTPs on the functions MACs perform, especially around billing, claims processing, and payment.  The materials (PDF) from each of these calls are now available. 

Opioid Treatment Programs (OTP)

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


Overview

 

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:
05/01/2020 12:02 PM