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Opioid Treatment Program (OTP) Update
Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will provide reimbursement for opioid treatment programs (OTP) as outlined in this policy. In accordance with Centers for Medicare and Medicaid Services (CMS), Blue Cross NC will limit reimbursement for OTPs to the codes G1028, G2067 through G2080, and G2215 to G2216. This communication is an update to our previous policy posted in January 2020.
Following Substance Abuse and Mental Health Services Administration (SAMHSA) guidance, a maximum take-home supply of one month of medication is allowed. Therefore, Blue Cross NC will limit the add-on codes for take home supply of methadone and oral buprenorphine (G2078 and G2079) to be billed 3 times in 28 days (in addition to the weekly bundled payment code).
Key Reimbursement Guidelines:
- OTP providers may only be reimbursed using the bundled payment codes G1028, G2067 through G2080, and G2215 to G2216 on CMS-1500 form.
- Only OTP providers are eligible for reimbursement using G1028, G2067 through G2080, and G2215 to G2216.
- Place of service 58 (non-residential opioid treatment facilities) is required for all claims submitted by OTPs.
- Reimbursement for bundled weekly OTP services (G2067-G2075) is limited to once per 7 days. When multiple drugs are provided to a member in the same week, the drug provided for the majority of the week should be filed.
- Consistent with FDA labeling, reimbursement for:
- Weekly OTP services using G2069 and G2073 is limited to once per 28 days.
- Weekly OTP services using G2070 and G2072 is limited to once per 180 days.
- Drug take home supply (G2078 and G2079) is limited to three (3) units per 28 days.
Billing and Coding
HCPCS Code | Description |
|---|---|
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 |
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) |
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) |
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) |
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) |
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) |
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) |
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) |
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) |
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) |
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 health care professional under the supervision of a program physician 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 |
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 |
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 |
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 |
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 |
G2215 | Take-home supply of nasal naloxone; 2-pack of 4mg 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 |
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 |
These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC members who seek care in other states.
Related policy can be accessed via the following document: Treatment for Opioid Use Disorder (PDF)
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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