Medicare Now Covers Outpatient Treatment for Opioid Addiction

Recognizing the huge problems caused by opioid addiction in the United States, Medicare is adding a new outpatient opioid treatment benefit, paying for methadone and related treatment in certain facilities.

Under a new rule taking effect in January 2020, Medicare will now provide payment to opioid treatment programs (OTPs), also known as methadone clinics, as part of Medicare Part B. OTPs are the only locations where people addicted to opioids can receive methadone as part of their treatment.

Under the new OTP benefit, Medicare covers:

U.S. Food and Drug Administration (FDA)-approved opioid treatment medications (such as methadone)

Dispensing and administration of the treatment medications (if applicable)

Substance use counseling

Individual and group therapy

Toxicology testing

Intake activities

Periodic assessments

For beneficiaries who are eligible for both Medicare and Medi-Cal, Medi-Cal paid for methadone treatment. Now, once the OTP is enrolled in Medicare, Medicare will become the primary payer for these beneficiaries. Medi-Cal should continue to cover the service during the transition. Medicare Advantage plans should also allow coverage of OTPs that are not in their network while they assist beneficiaries in transitioning to an in-network OTP.

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Elise Lampert, Esq.

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