Opioid Treatment Programs and HCPCS G2067 through G2075 Weekly Bundles
Only Opioid Treatment Programs (OTPs) can submit claims with HCPCS codes G2067 through G2075. These services are episodes of care lasting seven days in a row. It is important to note that OTPs cannot bill for the same beneficiary more than once per seven-day period.
There are limited situations, such as a beneficiary starting treatment at the OTP in the middle of the OTP's standard weekly billing cycle, that may be an exception.
For the codes that describe a weekly bundle, HCPCS codes G2067 through G2075, one week is defined as seven days in a row. OTPs may choose to apply a standard billing cycle by setting a particular day of the week to begin all episodes of care. In this case, the date of service would be the first day of the OTP’s billing cycle. If a beneficiary starts treatment at the OTP in the middle of the OTP’s standard weekly billing cycle, the OTP may still bill the applicable code for that episode of care provided that it meets the threshold to bill for the code.
The threshold for billing the codes describing weekly episodes, HCPCS codes G2067-G2075, is the delivery of at least one service in the weekly bundle, from either the drug or non-drug component.
OTPs may also choose to adopt weekly billing cycles that vary across beneficiaries. Under this approach, the initial date of service will depend on the day of the week when the beneficiary was first admitted to the program or when Medicare billing began. With this approach, when a beneficiary is beginning treatment or re-starting treatment after a break in treatment, the date of service would be the first day the beneficiary was seen and the date of service for subsequent consecutive episodes of care would be the first day after the previous seven day period ends.