Starting January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) plans to pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder treatment services. This includes medication-assisted treatment medications, toxicology testing, and counseling (when given to people with Medicare Part B). This is in line with the 2020 Physician Fee Schedule’s proposed rule CMS-1715-P. 


Opioid Use Disorder Treatment Services

Opioid Use Disorders Treatment services include:


  • Opioid agonist and antagonist treatment medications (including oral, injected, or implanted versions) that are approved by the Food and Drug Administration (FDA) under section 505 of the Federal Food, Drug, and Cosmetic Act (FFDCA) (21 U.S.C. 355) for use in the treatment of OUD;
  • Dispensing and administration of such medications, if applicable;
  • Substance use counseling by a professional to the extent authorized under state law to furnish such services;
  • Individual and group therapy with a physician or psychologist (or another mental health professional to the extent authorized under state law);
  • Toxicology testing; and
  • Other items and services that the Secretary determines are appropriate (but in no event to include meals or transportation).


Get ready to participate in the new benefit now!


Participate in the New Benefit with a SAMHSA Certification

To participate in the new benefit program, the OTPs should enroll in Medicare. Of course, before that, they should have full certification from the Substance Abuse and Mental Health Services Administration (SAMHSA), in addition to being accredited by a SAMHSA-approved accrediting body.


Learn more details with the help of WCH

To know more about SAMHSA’s requirements, visit SAMHSA’s Certification of Opioid Treatment Programs (OTPs) webpage, and see proposed rule CMS-1715-P. Follow our monthly publications for further details, or contact us today!