CY2021_NPRM_Payment_Rates_for_OpioidTreatmentProgram_OTP_CMS-1734-P				
HCPCS	Descriptor	Drug Cost	Non-drug Cost*	Total Cost
G2067	"Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$35.28 	$172.21 	$207.49 
G2068	"Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$79.39 	$172.21 	$251.60 
G2069	"Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$1,645.78 "	$178.65 	"$1,824.43 "
G2070	"Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$4,793.18 "	$407.86 	"$5,201.04 "
G2071	"Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$0 	$427.32 	$427.32 
G2072	"Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$4,793.18 "	$626.97 	"$5,420.15 "
G2073	"Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$1,160.52 "	$178.65 	"$1,339.17 "
G2074	"Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$0 	$161.71 	$161.71 
G2075	"Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	-	-	-
Intensity Add-on Codes				
G2076	"Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patients short-term goals and the tasks the patient must perform to complete the short-term goals; the patients requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure."	$0 	$179.46 	$179.46 
G2077	Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$0 	$110.28 	$110.28 
G2078	Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$35.28 	$0 	$35.28 
G2079	Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$79.39 	$0 	$79.39 
G2080	"Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure."	$0 	$30.94 	$30.94 
GOTP1	Take-home supply of nasal naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$89.63 	$0 	$89.63 
GOTP2	Take-home supply of auto-injector naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$178.00 	$0 	$178.00 
"*Drug pricing subject to change pending additional data. The estimated payment amounts in this table are based on data files posted at the time of the drafting of this proposed rule. We will develop the final pricing for CY 2021 using the most recent data files available at the drafting of the CY 2021 PFS final rule. The non-drug cost does not reflect an increase based upon the Medicare Economic Index (MEI), however, this will be reflected in the rates that will be posted with the CY 2021 PFS final rule."				
