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