Opioid Treatment Programs New Information, Billing, and Payment

New Information for 2022

The Calendar Year (CY) 2022 Physician Fee Schedule final rule includes information for Medicare-enrolled Opioid Treatment Programs (OTPs):

  • After the end of the COVID-19 public health emergency (PHE), CMS will allow audio-only interactions (like telephone calls) when audio-video communication isn’t available to the patient or the patient can’t or won’t agree to 2-way audio-video communication
  • CMS established HCPCS code G1028 for a higher dose of naloxone hydrochloride nasal spray in response to the increase in overdoses from illicitly-manufactured fentanyl, which can require a more potent overdose reversal drug

After the PHE ends, CMS expects OTPs to add the following modifiers on claims for HCPCS code G2080:

  • Modifier 95: for counseling and therapy provided using audio-video telecommunications
  • Modifier FQ: for counseling and therapy provided using audio-only telecommunications

Additionally, CMS issued an interim final rule with comment period to keep the methadone payment amount at the CY 2021 rate for the duration of CY 2022. CMS encourages OTPs to review the rule and submit formal comments by January 3, 2022.

CMS updated the OTP webpages and the Billing & Payment (PDF) booklet with this and other new information.

Medicare Billing and Payment - Revised

Learn about new HCPCS codes and modifiers (PDF):

  • Use HCPCS code G1028 - Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 mL nasal spray
  • Use HCPCS code G2215 - Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 mL nasal spray
  • Add Modifier 95 to your claim for counseling and therapy you provide by audio-video telecommunications using HCPCS code G2080 after the Public Health Emergency (PHE) ends
  • Add Modifier FQ if you provide audio-only counseling or therapy services after the PHE ends
  • See updated Table 1: MAT Codes, Descriptors, & National Medicare Payment Rates to include updated rates, new HCPCS code G1028 and revised definition of HCPCS code G2215


            Last Updated Thu, 23 Dec 2021 18:56:10 +0000