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Medicare pays for opioid treatment as of Jan. 1, 2020

As of Jan. 1, 2020, the Centers for Medicare & Medicaid Services pays opioid treatment programs (OTPs) through bundled payments for opioid use disorder treatment services for people with Medicare Part B (medical insurance). 

OTPs should enroll in Medicare as soon as possible to bill Medicare in 2020, as Part B members begin using this benefit to cover their opioid use disorder treatment services.

Refer to CMS’s OTP webpage and the CY 2020 Physician Fee Schedule Final Rule for enrollment, coding and claims information.

Under the new OTP benefit, Medicare covers:

  • U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
  • Dispensing and administration of MAT medications (if applicable)
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments

OTP

Medicare-enrolled OTPs must contract with Magellan to serve Medicare Advantage plans that we manage. 

Opioid provider treatment requirements:

  1. Get certified/accredited: OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent, SAMHSA-approved accrediting body. For SAMHSA certification, OTPs must comply with all pertinent state laws and regulations, and all regulations enforced by the Drug Enforcement Administration. For more information on the accreditation process, visit SAMHSA’s Certification of Opioid Treatment Programs (OTPs) webpage.
  2. Get enrolled: Certified, accredited providers must enroll in Medicare to bill OTP services under Medicare Part B. Refer to the OTP Medicare Enrollment Fact Sheet (PDF) to learn more about the enrollment process and the documentation you’ll need to get started. 
  3. Get contracted: Medicare-enrolled OTPs must contract with Magellan to serve Medicare Advantage plans that we manage. If you are already contracted with Magellan for the Medicare network, then you’ll need to have your contract amended to add the OTP services. If you are not already contracted with Magellan for the Medicare network, you’ll need to complete the Medicare enrollment process first and then complete the credentialing and contracting process to become an in-network provider for OTP services.

Magellan's next steps

Magellan began covering the OTP benefit for members of our Medicare Advantage behavioral health plans as of Jan. 1, 2020. We are sending contracts to SAMHSA-certified OTPs in areas where we support Medicare Advantage members. View answers to frequently asked questions (PDF), or contact your field network representative to learn more. If you’re unsure who your field network representative is, contact our Provider Services Line at 1-800-788-4005.

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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