CY2021_Final Rule_Payment_Rates_for_OpioidTreatmentProgram_OTP_CMS-1734-F					
HCPCS	Descriptor	Drug Cost	Non-drug Cost	Total Cost	
G2067	"Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$37.38 	$174.62 	$212.00 	
G2068	"Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$81.08 	$174.62 	$255.70 	
G2069	"Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$1,638.92"	$181.15 	"$1,820.07 "	
G2070	"Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$4,547.13 "	$413.57 	"$4,960.70 "	
G2071	"Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$0 	$433.30 	$433.30 	
G2072	"Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$4,547.13 "	$635.75 	"$5,182.88 "	
G2073	"Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	"$1,228.91 "	$181.15 	"$1,410.06 "	
G2074	"Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	$0 	$163.97 	$163.97 	
G2075	"Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program)"	-		-	
Intensity Add-on Codes					
G2076	"Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patients short-term goals and the tasks the patient must perform to complete the short-term goals; the patients requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure."	$0 	$181.97 	$181.97 	
G2077	Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$0 	$111.82 	$111.82 	
G2078	Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$37.38 	$0.00 	$37.38 	
G2079	Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$81.08 	$0.00 	$81.08 	
G2080	"Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure."	$0 	$31.37 	$31.37 	
G2215	Take-home supply of nasal naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	$89.63 	$2.53 	$92.16 	
G2216	Take-home supply of injectable naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); List separately in addition to code for primary procedure.	Contractor-priced	$2.53 	Contractor-priced	
"*In accordance with the annual update methodology finalized in the CY 2020 PFS final rule (84 FR 62667), the drug component for HCPCS codes G2067-G2080 has been updated for CY 2021 using the most recent data files available at the time of drafting this rule and the non-drug component for HCPCS codes G2067-G2080 has been updated based on the Medicare Economic Index (MEI), which reflects an increase of 1.4% for CY 2021."					
