Opioid Treatment Programs (OTP)

New for CY 2024:

The CY 2024 Physician Fee Schedule final rule:

  • Extends the flexibility through the end of CY 2024 to provide periodic assessments via audio-only when video isn’t available, when authorized by SAMHSA and DEA

The CY 2024 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System  final rule:

  • Establishes a weekly payment adjustment for an Intensive Outpatient Program (IOP) provided by an OTP for opioid use disorder treatment; the IOP service:
    • Must be medically reasonable and necessary 
    • Can’t be duplicative of any service paid for under any bundled payments billed for an episode of care in a given week

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
  • Intensive outpatient program services beginning January 1, 2024
Page Last Modified:
12/13/2023 04:28 PM
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