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Starting January 1, 2020 Medicare Part B began covering a new Opioid Treatment Program (OTP) benefit. The Centers for Medicare & Medicaid Services (CMS) pay OTPs through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B.

Under the new OTP benefit, Medicare covers:

  • U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
  • Dispensing and administration of MAT medications (if applicable)
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments

All states must also cover OTP in their Medicaid programs effective October 2020 subject to an exception process as defined by the Secretary. For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who previously got OTP services through Medicaid, starting January 1, 2020, Medicare became the primary payer for OTP services. OTP providers need to enroll as a Medicare provider in order to bill Medicare. CMS recently issued a memo emphasizing the importance of ensuring continuity of care for dually eligible enrollees currently obtaining treatment from an OTP provider through Medicaid.

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