Opioid Treatment Program Weekly Bundle Billing

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 patient more than once per seven-day period.

There are limited situations, such as a patient starting treatment at the OTP in the middle of the OTPs 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 is the first day of the OTPs billing cycle. If a patient starts treatment at the OTP in the middle of the OTPs standard weekly billing cycle, the OTP may bill the applicable code for that episode of care if the threshold to bill the code is met.

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 choose to adopt weekly billing cycles that vary depending on the patient. Under this approach, the initial date of service will depend on the day of the week when the patient is first admitted to the program or when Medicare begins billing. With this approach, when a patient is beginning treatment or re-starting treatment after a break in treatment, the date of service is the first day the patient is seen by the OTP. The date of service for subsequent consecutive episodes of care is the first day after the previous seven-day period ends.

HCPCS codes G2067–G2075 are primary codes for OTP weekly episodes of care. There are also add-on codes for certain services performed by OTPs that represent specific services that are not weekly bundles. Each claim for an OTP episode of care must include a primary code. Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. If an add-on service is performed, it should be reported on the same claim as the primary code.

References

• Billing & Payment | CMS
• CMS Opioid Treatment Programs (OTP)