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

Submit Comments by September 6 – Calendar Year 2023 Physician Fee Schedule Proposed Rule

CMS issued the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule that includes proposals to strengthen Opioid Treatment Program (OTP) policies. See a summary of key provisions. Proposals include:

  • Revising pricing methodology for drug component of methadone weekly bundle and add-on code for take-home methadone supplies
  • Modifying payment rate for individual therapy in non-drug component of the bundled payments for episodes of care
  • Allowing OTP intake add-on code to initiate treatment with buprenorphine provided via 2-way audio-video communications technology or audio-only technology when audio-video technology isn’t available and all requirements are met
  • Clarifying OTPs can bill for medically reasonable and necessary services provided via mobile units

We encourage you to review the rule, and submit formal comments by September 6, 2022. 
 


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:
07/19/2022 12:06 PM