OTP Payment Rates
CY 2023 Final Rule Payment Rates for Opioid Treatment Programs
Use this list to find the HCPCS code for a specific service. These rates reflect the national payment rates and don’t include adjustments based on locality.
| HCPCS | Descriptor | Drug Cost | Non-drug Cost | Total Cost |
|---|---|---|---|---|
| G2067 | Medication-assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $39.29 | $209.46 | $248.75 |
| G2068 | Medication-assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $80.53 | $209.46 | $289.98 |
| G2069 | Medication-assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $1,737.90 | $216.38 | $1,954.28 |
| G2070 | Medication-assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $4,950.00 | $462.69 | $5,412.69 |
| G2071 | Medication-assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | - | $483.61 | $483.61 |
| G2072 | Medication- assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $4,950.00 | $698.16 | $5,648.16 |
| G2073 | Medication-assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | $1,340.64 | $216.38 | $1,557.02 |
| G2074 | Medication-assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | - | $198.17 | $198.17 |
| G2075 | Medication-assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | - | - | - |
| Intensity Add-on Codes | ||||
| G2076 | Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician, or a primary care physician, or an authorized healthcare professional under the supervision of a program physician, or qualified personnel that includes preparation of a treatment plan that includes the patient’s short-term goals and the tasks the patient must perform to complete the short-term goals; the patient’s requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | - | $192.85 | $192.85 |
| G2077 | Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | - | $118.51 | $118.51 |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | $39.29 | - | $39.29 |
| G2079 | Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | $80.53 | - | $80.53 |
| G2080 | Each additional 30 minutes of counseling in a week of medication-assisted treatment, (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | - | $33.25 | $33.25 |
| G2215 | Take-home supply of nasal naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | $75.94 | $2.68 | $78.62 |
| G2216 | Take-home supply of injectable naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure | Contractor-priced | Contractor-priced | Contractor-priced |
| G1028 | Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 mL nasal spray (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure) | $125.00 | $2.68 | $127.68 |
* CMS updated the drug component for CY 2023 based on the methodology finalized in the CY 2020 Physician Fee Schedule final rule, using the most recent data files available when we drafted this rule (with the exception of methadone). We updated the non-drug component based on the Medicare Economic Index, which reflects an increase of 3.8% for CY 2023.
Page Last Modified:
09/06/2023 04:51 PM