How to Become a Medicare-Enrolled OTP Supplier

Table of Contents

• How to Become a Medicare-Enrolled OTP Supplier
• National Government Services Provider Enrollment Call Center
• NGS Provider Enrollment Mailing Address

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How to Become a Medicare-Enrolled OTP Supplier

OTPs with current, valid and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body; including the DEA and State licensure, can enroll in the Medicare program to bill for services after Medicare enrollment approval.

Part B OTP enrollment was effective for dates of service on or after 1/1/2020. CMS extended coverage for the Medicare OTP enrollment effective for dates of service on or after 1/1/2021 to include Part A outpatient or freestanding hospital services. Medicare only allows either Part A or Part B enrollment for the TIN per state.

OTPs that are currently enrolled but are changing their OTP enrollment from a Form CMS-855B to a Form CMS-855A (or vice versa) must successfully complete the limited level of categorical screening under Section 424.518(a) if the OTP has already completed, as applicable, the moderate or high level of categorical screening under Section 424.518(b) or (c), respectively.

If you want to switch your billing provider type:

• Payment of the application fee is required
• Submit via PECOS or appropriate CMS-855 form with all required documentation
• The effective date of the newly requested enrollment will be the same as the prior established OTP enrollment upon completion
• The prior established enrollment will be end dated when the newly requested enrollment is processed and approved
• Do not submit claims for the newly requested enrollment until the approval letter is received

Gather necessary information/documentation prior to submission.

• An NPI will be necessary to enroll
• A copy of your letter of certification from SAMHSA for each practice location and each signed and dated renewal letter from SAMHSA
• A detailed organizational chart. (like the one you used for your SAMHSA certification)
• Names, contact information and TIN and/or SSNs for all individuals or organizations with managing control and/or ownership interest in the OTP. (including Program Sponsor and Medical Director identified)
• Addresses and phone numbers for all practice locations of the OTP
• Copies of legal record regarding any convictions, exclusions, revocations, and suspensions associated with the entity or ownership or managing control organizations or individuals
• Confirmation from IRS confirming Tax Identification Number with Legal Business Name (CP 575 or CP147c) and if non-profit the 501c3 notification
• If a LLC is disregarded entity, include Form 8832 from the IRS
• CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement with bank confirmation letter or voided check verifying legal business name
• CMS-1561 Health Insurance Benefit Agreement signed and dated by authorized official of entity enrollment
• Copy of an attestation for government entities and tribal organizations, if applicable
• Participation is mandatory for the OTP supplier; the CMS 460 Medicare Participating Physician or Supplier Agreement is optional

Review Opioid Treatment Programs (OTPs) Medicare Enrollment, and CMS Opioid Treatment Programs: Enrolling in Medicare. (audio & transcript)

Submit electronically via PECOS or via paper application of the CMS-855A Institutional Providers or CMS-855B Clinic/Group Practices and Certain Other Suppliers with the CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement paper form. An application fee applies for initial enrollment of an OTP provider, as well as when revalidating and adding a new practice location to the enrollment. Payment is online through PECOS. CMS considers hardship exceptions on a case by case basis and this request must be submitted with the application.

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National Government Services Provider Enrollment Call Center

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NGS Provider Enrollment Mailing Address

Reviewed 9/3/2024