Effective for dates of service on and after 1/1/2020, CMS pays OTPs, through weekly bundled payments, to deliver OUD treatment services to Medicare beneficiaries.
OTP is a Medicare Part B benefit that provides coverage for outpatient OUD treatment services. This benefit does not include inpatient opioid treatment.
With the release of the final rule, OTPs fully certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body can enroll in the Medicare Program to bill for services after Medicare enrollment approval.
The Medicare OTP benefit includes weekly bundled payment for:
- U.S FDA-approved opioid agonist and antagonist MAT medications
- Dispensing and administration of MAT medications (if applicable)
- Substance use counseling
- Individual and group therapy
- Toxicology testing
- Intake activities
- Periodic assessments