Office-Based Opioid Use Disorder (OUD) Treatment Billing

In the CY 2020 Physician Fee Schedule final rule, CMS included new coding and payment for a monthly bundle of services for the treatment of OUD that includes:

Overall management
Care coordination
Individual and group psychotherapy
Substance use counseling
Add-on code for additional counseling

This is a way for clinicians to bill for a group of services in the office setting similar to the services covered under the Opioid Treatment Program benefit for clinics. Clinicians providing these bundled services to Medicare patients should use these codes:

HCPCS Code for Office-Based OUD Treatment	Description
G2086	In the first calendar month: Developed the treatment plan Coordinated care Provided at least 70 minutes of individual therapy and group therapy and counseling
G2087	In a subsequent calendar month: Coordinated care Provided at least 60 minutes of individual therapy and group therapy and counseling
G2088	Coordinated care Provided more than 120 minutes of therapy and counseling Note: Bill each additional 30 minutes separately and include the code for primary procedure

HCPCS Code for Office-Based OUD Treatment

Description

G2086

In the first calendar month:

Developed the treatment plan
Coordinated care
Provided at least 70 minutes of individual therapy and group therapy and counseling

G2087

In a subsequent calendar month:

Coordinated care
Provided at least 60 minutes of individual therapy and group therapy and counseling

G2088

Coordinated care
Provided more than 120 minutes of therapy and counseling
Note: Bill each additional 30 minutes separately and include the code for primary procedure

Use these codes to bill for individual services:

Office/outpatient E/M visit codes (PDF), psychotherapy, and any other code that is medically reasonable and necessary
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services (PDF) codes