Opioid Treatment Programs (OTP)

New for CY 2025:

The CY 2025 Physician Fee Schedule final rule:

• Establishes permanent flexibility for OTPs to provide periodic assessments via audio-only communications technology when video isn’t available, when authorized by SAMHSA and DEA
• Allows OTPs to furnish the intake add-on code via two-way audio-video communications technology when billed for the initiation of treatment with methadone (HCPCS code G2076) if an OTP can adequately evaluate the patient via an audio-visual telehealth platform
• Updates payment for social determinants of health (SDOH) risk assessments as part of intake activities within OUD treatment services furnished by OTPs, if medically reasonable and necessary to adequately reflect additional effort for OTPs
• Updates payment for periodic assessments to include payment for SDOH risk assessments to reflect additional reassessments that OTPs may conduct throughout treatment 
• Allows payment for a new injectable buprenorphine product on a weekly or monthly basis
• Clarifies a billing requirement that OTPs must include an OUD diagnosis code on claims for OUD treatment services, consistent with Medicare coverage and payment provisions under the Social Security Act
• Creates new add-on codes for:
  • Coordinated care and referral services
  • Patient navigational services
  • Peer recovery support services
  • Nalmefene hydrochloride nasal spray, indicated for the emergency treatment of known or suspected opioid overdose