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 2021

  • New covered services include FDA-approved opioid antagonist medications, specifically naloxone, for emergency treatment of opioid overdose, as well as overdose education provided in conjunction with opioid antagonist medication
  • New codes for nasal and injectable naloxone (see the Billing & Payment Fact Sheet (PDF) for more details on billing for naloxone)
  • OTPs may conduct periodic assessments via two-way interactive audio-video communication technology

 

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:
10/14/2021 02:47 PM