Opioid Use Disorder Screening & Treatment
Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners. If you diagnose your patient with OUD, we also pay for treatment services.
- When Can I Screen My Patients for OUD?
- During required screening elements of Medicare’s Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AWV)
- During visits in physicians’ offices and outpatient hospital settings to screen people who may not seek substance use help. In these cases, you can offer Screening, Brief Intervention, & Referral to Treatment (SBIRT) treatment services.
- How Do I Bill for These Screenings?
Things to Know
You’re required to screen for OUD as part of the IPPE
You’re required to screen for OUD as part of the AWV
You’re required to screen for OUD as part of subsequent AWVs
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 5–14 minutes
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
- If I Diagnose a Patient with OUD, What are the Treatment Options?
We pay for certain treatment services:
- Evaluation & Management (E/M) visits for medication management
- Office-based Substance Use Disorder (SUD) treatment services
- Opioid Treatment Program (OTP) (a more comprehensive treatment)
- What’s an E/M Visit for Medication Management?
CPT codes 99202-99499 represent visits and services that involve evaluating and managing patient health. You can use E/M visits to provide medication management to make sure patients take medications properly as part of their recovery process. Medications prescribed for patients with OUD in the office setting could include buprenorphine and naltrexone. If your patient has Medicare Part D coverage, their plan may cover these medications.
Learn more about E/M visits in the Evaluation and Management Services Guide (PDF).
- What are Office-Based SUD Treatment Services?
Office-based SUD treatment services are a way for you to bill for a group of services in the office setting. We cover a monthly bundle of services (for patients who are prescribed buprenorphine or naltrexone in the office setting) for the treatment of OUD or other SUDs. Visit Office-Based Substance Use Disorder (SUD) Treatment Billing for more information.
If you’re treating your patient in the office but feel they may benefit from a more comprehensive treatment, refer them to an OTP.
- What are OTPs?
OTPs provide medications for opioid use disorder (MOUD), including methadone, buprenorphine, and naltrexone, for patients diagnosed with OUD. OTPs must be SAMHSA certified and accredited by an independent, SAMHSA-approved accrediting body. Consider referring your patient to an OTP if this specific MOUD is helpful to their recovery.
Part B pays for MOUD provided by an OTP. There’s no copayment for OTP services for Medicare patients, but the Part B deductible applies. Patients with Part B and an OUD diagnosis are eligible to get OUD treatment services at an OTP. Find a list of Medicare-enrolled OTPs.
Read our letter to physicians and non-physician practitioners to learn more about the behavioral health services Medicare pays for, and help improve the health of your patients.