Medicare billing updates for OTPs: What substance use disorder clinicians need to know  

If you’re working in an Opioid Treatment Program (OTP), you’ve probably heard about the latest changes to Medicare billing codes. These updates are designed to make things easier for clinicians like you and to improve care for your patients. Here’s a breakdown of the changes and what they mean for you and the people you care for.  

New billing options for non-drug services  

Medicare is now allowing OTPs to bill for important non-drug services, even during weeks when medication isn’t given. These can include counseling, therapy, or toxicology testing. That’s great news for patients who may be on monthly medications like buprenorphine or naltrexone.  

Why does this matter? Because these services are still an essential part of treatment, and now they’ll be reimbursed. This ensures that you’re compensated for the care you deliver between medication doses while continuing to help your patients stay on track.  

Telehealth flexibilities are here to stay  

One of the biggest shifts is the permanent flexibility for telehealth services. You can now provide counseling, therapy, and assessments over audio-video calls or even audio-only calls in certain cases. Interestingly, you’re also allowed to start treatment with medications like methadone or buprenorphine via telehealth if specific conditions are met.  

This change removes many barriers for patients in rural areas or those without access to reliable transportation. It means you can be there for your patients, even if they can’t make it to the clinic in person.  

Billing for intensive outpatient services  

If your program offers intensive outpatient services, you’ll now have the option to bill for them. Medicare allows billing if at least nine services are provided over seven days, and these services are certified as medically necessary.  

This update is critical for patients who need a higher level of care because of complex needs or a higher risk of relapse. Giving them access to more structured support could make a huge difference in their recovery.  

Add-on codes for enhanced care  

Medicare is also rolling out additional billing codes for services that go beyond treatment basics. These include care coordination, harm reduction, and peer recovery support.  

These codes offer the chance for a bigger view of patient care. Recovery doesn’t just happen through medication and therapy. It’s also critical to address life challenges, help build support systems, and guide patients through every step. These added services can go a long way in making recovery sustainable.  

Adjustments based on geography and economics  

Medicare isn’t taking a one-size-fits-all approach. Payment rates for non-drug services and additional care components will be adjusted annually based on your location and the Medicare Economic Index.  

This should help even the playing field for clinicians working across different regions with varying costs of living.  

Simplifying telehealth billing with modifiers  

To make telehealth billing more straightforward, new modifiers have been introduced. You’ll use Modifier 93 for audio-only services and Modifier 95 for audio-video calls.  

This ensures accurate billing for the type of telehealth services you’re providing and helps keep things organized on the administrative side.  

Removing outdated codes  

Medicare is also cleaning up the system by retiring obsolete codes for discontinued treatments, like the buprenorphine implant. Less clutter in the billing process means less room for confusion, which is always a good thing!  

Why these changes matter  

For you as a clinician, these updates mean better financial support and flexibility to provide the care your patients need. Billing systems and staff training will need to reflect the changes, but the benefits far outweigh the effort.  

For your patients, it means better access to care—even if they live far away or can’t visit in person. It also means financial barriers are lowered, thanks to Medicare’s zero copayment policy for OTP services (aside from the Part B deductible).  

Medicare’s new rules aim to make it easier for OTPs to deliver holistic, patient-centered care. Counseling, peer support, harm reduction, and telehealth options can now more easily be part of your daily work to help your patients achieve better outcomes.  

You’re already making life-changing differences in the lives of your patients every day. These updates are just one more way to support the amazing work you do.