Proper Billing for Opioid Treatment Program Weekly Bundles for HCPCS Codes G2067-G2075

Medicare introduced the OTP as a covered Part B benefit beginning with dates of service on and after 1/1/2020. Payment is made to Medicare-enrolled OTP providers as a weekly bundle that includes counseling and therapy, intake, patient assessments and MAT.

We recently identified billing inconsistencies on OTP claims, therefore, we are sharing proper billing criteria with all of our OTP providers. The purpose of this educational article is to ensure our Medicare-enrolled OTP providers are properly submitting claims and being paid accordingly. This article addresses billing for the weekly bundles (MAT and non-MAT).

Please be aware that claims processing edits will reject OTP claims that are not consistent with the billing criteria below. Once rejected, you will need to make the necessary billing corrections and submit a new claim.

• Date of Service = the first date of care for that week. Do not span “From” and “To” dates. Do not cross months on one claim
• Place of Service = 58
• Units of service = 1 (HCPCS description includes seven days)
• Billed amount = Geographically Adjusted Fee from Locality Adjusted Rates
• Each week must be billed on a separate line item

Please review Opioid Treatment Add-on Code G2078 and G2079 for MUE Values for instructions on billing these add-on codes for take home medication.

Please view the MLN Opioid Treatment Programs Medicare Billing and Payment Fact Sheet for additional information.

Posted 6/30/2020
Revised 8/31/2020