JM Part A 2021 Opioid Treatment Program (OTP) Rates


Rates are effective January 1, 2021.

North Carolina

Code
Modifier
Contractor Number
Locality
Fee
G2067
 
11502
00
$205.02
G2068
 
11502
00
$248.72
G2069
 
11502
00
$1,812.82
G2070
 
11502
00
$4,944.16
G2071
 
11502
00
$415.97
G2072
 
11502
00
$5,157.45
G2073
 
11502
00
$1,402.81
G2074
 
11502
00
$157.41
G2075
 
11502
00
$0.00
G2076
 
11502
00
$174.69
G2077
 
11502
00
$107.35
G2078
 
11502
00
$37.38
G2079
 
11502
00
$81.08
G2080
 
11502
00
$30.12
G2215
 
11502
00
$92.06
G2216
 
11502
00
$13.82

South Carolina

Code
Modifier
Contractor Number
Locality
Fee
G2067
 
11202
01
$202.05
G2068
 
11202
01
$245.75
G2069
 
11202
01
$1,809.74
G2070
 
11202
01
$4,937.13
G2071
 
11202
01
$408.60
G2072
 
11202
01
$5,146.64
G2073
 
11202
01
$1,399.73
G2074
 
11202
01
$154.62
G2075
 
11202
01
$0.00
G2076
 
11202
01
$171.60
G2077
 
11202
01
$105.45
G2078
 
11202
01
$37.38
G2079
 
11202
01
$81.08
G2080
 
11202
01
$29.58
G2215
 
11202
01
$92.02
G2216
 
11202
01
$13.75

Virginia

Code
Modifier
Contractor Number
Locality
Fee
G2067
 
11302
00
$210.78
G2068
 
11302
00
$254.48
G2069
 
11302
00
$1,818.80
G2070
 
11302
00
$4,957.81
G2071
 
11302
00
$430.27
G2072
 
11302
00
$5,178.43
G2073
 
11302
00
$1,408.79
G2074
 
11302
00
$162.82
G2075
 
11302
00
$0.00
G2076
 
11302
00
$180.70
G2077
 
11302
00
$111.04
G2078
 
11302
00
$37.38
G2079
 
11302
00
$81.08
G2080
 
11302
00
$31.15
G2215
 
11302
00
$92.14
G2216
 
11302
00
$14.01

West Virginia

Code
Modifier
Contractor Number
Locality
Fee
G2067
 
11402
16
$202.40
G2068
 
11402
16
$246.10
G2069
 
11402
16
$1,810.11
G2070
 
11402
16
$4,937.95
G2071
 
11402
16
$409.47
G2072
 
11402
16
$5,147.91
G2073
 
11402
16
$1,400.10
G2074
 
11402
16
$154.95
G2075
 
11402
16
$0.00
G2076
 
11402
16
$171.96
G2077
 
11402
16
$105.67
G2078
 
11402
16
$37.38
G2079
 
11402
16
$81.08
G2080
 
11402
16
$29.64
G2215
 
11402
16
$92.02
G2216
 
11402
16
$13.63

 





Last Updated: 01/19/2021