Opioid Treatment Programs (OTP)

New for 2023

The CY 2023 Physician Fee Schedule final rule does the following for Medicare-enrolled OTPs:

  • Revises pricing methodology for drug component of methadone weekly bundle and add-on code for take-home methadone supplies
  • Modifies payment rate for individual therapy in non-drug component of the bundled payments for episodes of care
  • Allows OTP intake add-on code to initiate treatment with buprenorphine provided via 2-way, interactive, audio-video technology or audio-only technology when audio-video technology isn’t available and all requirements are met
  • Extends the flexibility through the end of CY 2023 to provide periodic assessments via audio-only when video isn’t available, when authorized by SAMHSA and DEA
  • Clarifies OTPs can bill for medically reasonable and necessary services provided via mobile units

Opioid Treatment Programs (OTPs) provide medication-assisted treatment (MAT) for people diagnosed with an opioid use disorder (OUD). 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 people with Medicare Part B (Medical Insurance). 

Under the OTP benefit, Medicare covers:

  • U.S. FDA-approved opioid agonist and antagonist MAT medications
  • Dispensing and administering MAT medications, if applicable
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments
Page Last Modified:
09/11/2023 03:07 PM