CMS Expands Medicare Coverage for Treatment of Opioid Use Disorder

The Centers for Medicare & Medicaid Services (CMS) has expanded coverage for treatment of Medicaid beneficiaries with opioid use disorder (OUD).

The recently finalized 2020 Physician Fee Schedule creates a new enrollment category and benefit for providers who offer OUD treatment programs.

The rule also establishes payment codes for bundled payments, which include medication-assisted treatment medication and therapy.

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Additionally, starting January 1, 2020, providers who offer telehealth services will have three new CPT codes to use when billing for certain OUD treatment. Those codes apply to telehealth treatment that is part of a bundled care episode for OUD.

The first code, CPCS code G2086, will cover at least 70 minutes of office-based treatment for opioid use disorder and will include the development of a treatment plan, care coordination and individual therapy, as well as group therapy and counseling, according to the rule.

The next code, HCPCS code G2087, will cover at least 60 minutes during the next month for office-based OUD treatment, care coordination and various therapy and counseling.

The third code, HCPCS code G2088, will cover each 30 minute increment beyond the first two hours for office-based OUD treatment, care coordination and various therapy and counseling.

The rule was first proposed in July and was finalized this month.

While Medicaid is the primary payer for most behavioral health treatments, Medicare is becoming increasingly important in the space, especially when it comes to substance abuse. The Medicare population has the fastest growing prevalence of OUD compared to the general adult population, with more than 300,000 beneficiaries diagnosed with OUD in 2014, according to the rule.