Opioid Treatment Programs (OTP)

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

New for CY 2023

The CY 2023 Physician Fee Schedule final rule includes information 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 audio-video communications 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

We encourage OTPs to enroll in the Medicare program.

Read our Letter to OTP Program Sponsors and State Opioid Treatment Authorities (SOTAs) (PDF).