Payment Rates

Medicare-enrolled OTPs are paid flat dollar payment rates for the codes describing the OTP bundled services (HCPCS codes G2067 through G2080, and G2215 to G2216). Payment rates are based on the OTP provider’s geographic location.

CMS will update the payment rates annually. The annual rates are available on the Opioid Treatment Programs (OTP) webpage in the Billing and Payment section.

OTP Billing and Payment

OTP providers will use a two-step approach to identifying their specific flat-dollar payment rate:

• Step 1: Use the In the Locality Key document to find the locality and corresponding MAC numbers assigned to your OTP based on the State/Fee Schedule Area/County location of your practice.
• Step 2: Use the Locality Adjusted Rates document to find your locality and corresponding MAC numbers then, use the HCPCS code to find the geographically adjusted payment rate.

Reviewed 9/3/2024