OTP Code Descriptors and Proposed Approximate Payment Amounts				
HCPCS	Descriptor	Drug Cost**	Non-drug Cost***	Total Cost
Full weeks				
GXXX1	"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)"	$22.19 	$110.96 	$133.15 
GXXX2	"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)"	$97.02 	$110.96 	$207.98 
GXXX3	"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)"	"$1,580.00 "	$117.40 	"$1,697.40 "
GXXX4	"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)"	"$4,792.10 "	$211.46 	"$5,003.56 "
GXXX5	"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 	$227.32 	$227.32 
GXXX6	"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)"	"$4,792.10 "	$305.16 	"$5,097.26 "
GXXX7	"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)"	"$1,164.38 "	$117.40 	"$1,281.78 "
GXXX8	"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 	$100.46 	$100.46 
GXXX9	"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)"	-	-	-
Partial episodes				
GXX10	"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); partial episode. Do not report with GXXX1. "	$11.10 	$55.48 	$66.58*
GXX11	"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); partial episode. Do not report with GXXX2. "	$48.51 	$55.48 	$103.99*
GXX12	"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); partial episode. Do not report with GXXX3. "	"$1,580.00 "	$67.17 	"$1,647.17*"
GXX13	"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); partial episode (only to be billed once every 6 months). Do not report with GXXX4. "	"$4,792.10 "	$161.23 	"$4,953.33*"
GXX14	"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); partial episode. Do not report with GXXX5. "	$0 	$177.09 	$177.09*
GXX15	"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); partial episode. Do not report with GXXX6. "	"$4,792.10 "	$254.93 	"$5,047.03*"
GXX16	"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); partial episode. Do not report with GXXX7. "	"$1,164.38 "	$67.17 	"$1,231.55*"
GXX17	"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); partial episode. Do not report with GXXX8. "	$0 	$50.23 	$50.23 
GXX18	"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); partial episode. Do not report with GXXX9."	-	-	-
Intensity Add-on code				
GXX19	"Each additional 30 minutes of counseling or therapy 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 	$26.60 	$26.60 
* Full drug cost and administration/dispensing fee included.				
"** Drug pricing subject to change pending additional data. Methadone drug costs are calculated here using TRICARE rates, oral buprenorphine drug costs are calculated here using NADAC data, and the other drug costs are calculated using the ASP data. The estimated payment amounts in this table are based on data files posted at the time of the drafting of this proposed rule. We would develop the final pricing for CY 2020 using the most recent data files available at the drafting of the CY 2020 PFS final rule.  "				
"*** The non-drug component of the methadone bundled payment rate (HCPCS code GXXX1) is $110.96 (TRICAREs posted rate of $133.15 minus the drug cost); the non-drug component of the oral buprenorphine bundled payment rate (HCPCS code GXXX2) is also $110.96 (crosswalked from the non-drug component of the methadone bundled payment rate). The non-drug component of both the injectable buprenorphine bundled payment rate (HCPCS code GXXX3) and the injectable naltrexone bundled rate (HCPCS code GXXX7) is $117.40 ($110.96 minus a $10.50 dispensing fee plus a $16.94 administration fee).  The non-drug components of the implanted buprenorphine bundled payment rates (HCPCS codes GXXX4, GXXX5, and GXXX6) are $211.46, $227.32, and $305.16 corresponding to implant insertion, removal, and insertion and removal, respectively ($110.96 minus a $10.50 dispensing fee plus the corresponding PFS non-facility rate for HCPCS codes G0516, G0517, and G0518).  The non-drug component of the no medication bundled payment rate (HCPCS code GXXX8) is $100.46 ($110.96 minus a $10.50 dispensing fee).  We are proposing that the codes describing a medication not otherwise specified (HCPCS codes GXXX9 and GXX18) would be contractor priced, but would expect the non-drug component for those bundled payments to also be based on a crosswalk to the TRICARE rate, adjusted for any applicable administration and dispensing fees.  The non-drug component of the codes describing partial episodes (HCPCS codes GXX10, GXX11, GXX12, GXX13, GXX14, GXX15, and GXX16) are calculated based and half of the rate for the non-drug component of the full weekly bundled payment, adjusted to remove the cost of daily administration of an oral drug.  Finally, the non-drug component for HCPCS code GXX19 is calculated based on rates set by state Medicaid programs for similar services.  All non-drug components of the valuations would be geographically adjusted as discussed in the locality adjustment section of this proposed rule."				
				
				
				
				
				
				
