## **What are opioid treatment programs?**
Opioid treatment programs (OTPs) are specialized clinics designed to provide comprehensive medication-assisted treatment (MAT) for individuals diagnosed with opioid use disorder. These programs offer a weekly bundle of services that include the administration of methadone or other FDA-approved medications, combined with essential therapeutic support to help patients in their recovery journey.
Patients enrolled in an opioid treatment program receive individualized care centered on person-centered treatment goals. This care typically begins with an initial medical examination and a fully documented physical evaluation to assess the patient’s health status and treatment needs. Throughout their treatment, patients participate in individual and group therapy sessions, which encompass group therapy and substance use counseling to address behavioral health challenges and promote sustained recovery.
OTPs often provide toxicology testing to monitor patient adherence and detect any concurrent substance use, ensuring safe and effective treatment. These programs also emphasize navigating recovery support services, coordinating care that may involve the patient’s primary care physician and other healthcare providers to support holistic health.
Medicare-enrolled opioid treatment programs adhere to strict guidelines to ensure quality care and proper documentation. These services are designed to be flexible and responsive to each patient’s unique circumstances, providing both medical and psychosocial support to improve outcomes.
By integrating medication management with counseling and comprehensive recovery support services, OTPs help individuals manage their addiction, reduce withdrawal symptoms, and prevent relapse. The combination of medication-assisted treatment and psychosocial interventions is proven effective in supporting long-term recovery from opioid dependence.
## **HCPCS code G2067 documentation requirements**
Proper documentation is essential to ensure accurate billing and compliance with payer policies. Key documentation elements include:
- Include the patient's name, date of birth, and medical record number to ensure proper identification.
- Document the patient's diagnosis, such as opioid use disorder, to support the necessity of MAT services.
- Provide a detailed treatment plan that outlines the goals, interventions, and expected outcomes of the MAT services.
- Record the specific services provided, including the type of medication administered, dosage, and administration method.
- Include progress notes that document the patient's response to treatment, any side effects, and adjustments made to the treatment plan.
- Ensure that all necessary consent forms are signed and included in the patient's record.
- Include documentation of the non-drug component of the treatment, such as counseling or therapy sessions, to support the comprehensive nature of the treatment.
- Accurately document the patient's substance use history and current status to support the necessity of MAT services.
## **G2067 billing requirements**
Proper billing ensures compliance with payer policies and facilitates appropriate reimbursement. Key billing requirements include:
- Clearly identify G2067 as the primary procedure code for the services provided during the treatment session.
- G2067 is a weekly bundled payment code, encompassing various services provided during the treatment week.
- Be aware of the national payment rates associated with G2067 to ensure proper reimbursement.
## **Other relevant codes**
G2068 – Opioid treatment program (OTP) Weekly Bundle for Non-Methadone MAT
G2065 – Opioid treatment program (OTP) Initial Service Bundle
G2078 – Opioid treatment program (OTP) Take-Home Medication Service
Frequently asked questions
