Medication Assisted Treatment Codes for Medicaid

We will use New Hampshire as an example here for medication assisted treatment codes medicaid and the managed care organizations.
 
 
Medication-assisted treatment (MAT) codes for New Hampshire Medicaid
New Hampshire Medicaid utilizes a combination of CPT and HCPCS codes for billing MAT services, including specific codes for office visits and bundled services in Opioid Treatment Programs (OTPs). 

In order to reduce the denial rate of submitted claims, follow the best practices outlined

1. Office visits
   • Established patient office visits (99211-HF to 99215-HF): These codes, with the -HF modifier, are used to bill for MAT services during established patient office visits, with the specific code depending on the complexity of the visit.
   • New patient office visits (99202-HF to 99205-HF): Similar to established patient visits, these codes (with -HF modifier) are used for new patients receiving MAT services, varying with visit complexity. 
   
2. Bundled services in Opioid Treatment Programs (OTPs)
   
   Weekly bundles: These codes cover a week’s worth of MAT services in an OTP, including dispensing/administration of medication, counseling, and toxicology testing.
   
   Note: The OTP bundle codes G2067–G2080 are the Medicare OTP code set; New Hampshire Medicaid adoption and fee schedules may differ, so confirm coverage and rates against the current NH Medicaid fee schedule.
   
   ◦ G2067: Methadone
   ◦ G2068: Oral Buprenorphine
   ◦ G2069: Injectable Buprenorphine
   ◦ G2073: Naltrexone
   ◦ G2074: Not including drug
   ◦ G2075: Medication not otherwise specified
   • Intake and periodic assessment:
   ◦ G2076: Intake activities for new patients.
   ◦ G2077: Periodic assessment for ongoing care.
   • Take-home supply:
   ◦ G2078: Take-home supply of methadone (up to 7 additional days).
   ◦ G2079: Take-home supply of oral buprenorphine (up to 7 additional days).
   • Counseling:
   ◦ G2080: Each additional 30 minutes of counseling or therapy.
   • Naloxone:
   ◦ G2215: Take-home supply of nasal naloxone.
   ◦ G2216: Take-home supply of injectable naloxone.
   ◦ G1028: Take-home supply of nasal naloxone (2-pack of 8mg per 0.1 mL nasal spray).
   • Intensive Outpatient Program (IOP) services:
   ◦ G0137: IOP services (weekly bundle for 7-day period).
   • Coordinated care and patient navigation:
   ◦ G0534: Coordinated care and/or referral services (additional 30 minutes).
   ◦ G0535: Patient navigational services (additional 30 minutes).
   • Peer Recovery Support:
   ◦ G0536: Peer recovery support services (additional 30 minutes). 
   Note: G0137 and the G0534–G0536 care-coordination, patient-navigation, and peer-recovery codes are newer Medicare add-on codes; confirm current coverage and rates against the applicable NH Medicaid / payer fee schedule before submitting claims.
   Important considerations
   
   Modifiers
   
   • Modifier HF: The -HF modifier is crucial for indicating that the service is related to MAT and ensuring proper reimbursement.
   • Billing OTP services: OTPs are Medicare-enrolled and utilize specific HCPCS codes for bundled services.
   • Separate claims for different services: If MAT is provided on the same day as a medical visit, you may need to bill these services on separate claims using the appropriate codes and modifiers.