How to Maximize Reimbursement For MAT Services

Medication-Assisted Treatment (MAT) is a powerful approach to treating opioid use disorder (OUD) by combining FDA-approved medications with counseling and behavioral therapies. Though MAT improves patient outcomes, healthcare providers often face challenges with reimbursement due to complex billing rules, payer-specific requirements and frequent regulatory changes. Maximizing reimbursement for MAT services ensures providers can sustain and expand these essential programs.

This blog explains how providers can improve their billing process, meet compliance standards, and optimize revenue to support high-quality MAT care.

Core Elements of MAT Billing to Maximize Reimbursement

It is critical to understand the foundational components of MAT billing to multiply the reimbursement. The providers should focus on the following crucial elements:

• Accurate Medication Coding

Medications used in MAT require specific HCPCS codes for billing--

• G2067: Methadone treatment in an outpatient setting
• G2068: Buprenorphine treatment in an outpatient setting
• J0572: Buprenorphine/naloxone (oral) with dosage ≤3 mg

Using the correct codes based on the medication and dosage is vital. Incorrect coding leads to claim denials or reduced payments. Providers should regularly update their code lists following CMS and payer announcements to avoid rejections.

• Identifying the Treatment Setting

Reimbursement depends on where MAT services are delivered:

• Outpatient Clinics: Use codes such as G2067 or G2068 based on the medication.
• Emergency Departments (ED): Use G2213 to bill for initiating MAT in the ED.
• Opioid Treatment Programs (OTP): May have bundled codes and special billing rules.

Properly documenting the treatment location and using correct place-of-service codes ensures claims are processed correctly.

• Documenting All Services Rendered

MAT is not just medication, but it includes counseling and behavioral therapies. The key billing codes for these services include:

• 90832 - 90837: Evaluation and Management (E/M) codes for counseling sessions of varying length
• 99408: Brief interventions and systematic substance abuse screening

Complete and thorough documentation showing the time spent, counseling details, and patient progress supports the medical necessity of services and prevents denials.

Practical Strategies to Maximize Reimbursement for MAT Services

Maximizing healthcare reimbursement for MAT services requires focused strategies that address the unique billing and documentation challenges. The following approaches offer practical ways to improve claim acceptance, ensure compliance, and secure timely payments for the comprehensive care that MAT programs provide:

• Use Real-Time Claim Validation

One of the most effective ways to reduce claim denials for MAT services is to implement billing software that performs real-time validation. This technology checks claims before submission to ensure all required fields are complete, the correct HCPCS and CPT codes for medications like buprenorphine (G2068) and methadone (G2067) are used, and documentation is sufficient for counseling or behavioral therapy services. In fact, catching errors before claims are sent to payers can drastically reduce rejection rates and speed up the reimbursement process. Ultimately, it improves cash flow and reduces administrative workload.

• Customize Billing by Payer

Insurance companies have varying policies for MAT reimbursement including different requirements for prior authorizations, bundled payment models, and coding preferences. For example, some Medicaid programs may bundle medication dispensing with behavioral counseling into a single payment, while commercial insurers might require separate billing for each service. Understanding and tailoring your billing workflows to meet these specific payer rules increases the chances that claims will be accepted on the first submission and reimbursed at the highest allowable rates. This also minimizes the risk of costly resubmissions or appeals.

• Integrate Clinical and Billing Systems

Using an integrated electronic health record and billing system designed specifically for MAT programs significantly improves the accuracy of billing submissions. These integrated platforms allow clinical notes regarding medication administration, dosage adjustments and counseling sessions to populate billing codes automatically. This reduces manual entry errors and ensures that all billable services are appropriately documented and submitted for reimbursement. When clinical and billing data are connected providers can more easily comply with payer documentation requirements and avoid denials related to incomplete or inconsistent information.

• Negotiate with Payers

Establishing a collaborative relationship with insurance payers can lead to improved reimbursement rates or alternative payment models that better reflect the comprehensive nature of MAT services. Providers should collect and present outcome data demonstrating MAT's effectiveness in reducing opioid use, lowering hospitalization rates, and improving patient well-being. With the help of such evidence, the providers can negotiate for higher payment rates, bundled payments that include both medication and behavioral therapies or participation in value-based care programs that reward quality outcomes. These partnerships help ensure that MAT programs are financially sustainable and adequately supported.

• Use Modifiers Correctly

Modifiers play a critical role in communicating the specifics of services provided during MAT treatment. For instance, when a patient receives both medication administration and behavioral counseling on the same day, modifiers like -59 (distinct procedural service) or U5 (denoting MAT services) clarify that these are separate billable activities. In fact the proper use of modifiers prevents confusion for payers and reduces the risk of partial or denied payments. Therefore, billing teams should be trained to understand when and how to apply modifiers correctly to ensure that the full scope of services is reimbursed.

• Ensure Proper Place of Service Codes

Accurate use of Place of Service codes is essential in MAT billing as reimbursement rates vary depending on where services are delivered. For instance, POS 11 is used for outpatient clinics, POS 23 for emergency departments where MAT induction may occur and POS 71 for opioid treatment programs. Using the correct POS code informs payers of the treatment environment and helps avoid claim rejections or incorrect payment amounts. Therefore proper attention to these details ensures claims reflect the true setting of care and receive appropriate reimbursement.

• Use Telehealth Billing Codes When Applicable

The expansion of telehealth has made it an important delivery method for MAT services, including medication management and counseling. Providers should ensure they use the correct telehealth CPT and HCPCS codes, such as G2012 for virtual check-ins or 99421 - 99423 for remote evaluations. Proper use of these codes allows providers to receive reimbursement for remote services, expanding access to care while maintaining revenue. Therefore, staying informed about telehealth billing policies for MAT helps providers fully capture payment opportunities in this growing care modality.

• Document Medication Dosages and Adjustments Clearly

Clear and detailed documentation of all medication dosages, administration dates and dosage changes during treatment is essential for MAT reimbursement. This documentation supports the use of specific medication codes like J0572 for buprenorphine/naloxone and justifies ongoing billing for medication management services. Payers often scrutinize dosage details to confirm medical necessity and appropriate treatment progression. As a result accurate records prevent claim denials related to insufficient documentation and ensure that providers are paid for all delivered medication services.

Outsource Billing to MAT Experts

Outsourcing medical billing and coding services to companies like 24/7 Medical Billing Services which specializes in MAT services can significantly improve reimbursement outcomes. These experts have in-depth knowledge of MAT-specific coding, payer requirements, and documentation standards. They also manage denials efficiently and keep up with regulatory changes affecting MAT billing. Outsourcing reduces administrative burdens on clinical staff, increases claim accuracy, and speeds up payments. This allows providers to focus their time and energy on patient care rather than complex billing tasks.

FAQs

Q1. Are all providers eligible to bill for MAT services?

Only providers meeting federal and state certification requirements can bill for MAT services.

Q2. Can group therapy sessions under MAT be billed?

If payer guidelines allow, and proper group therapy CPT codes are used.

Q3. Are lab tests during MAT reimbursable?

Drug screening and related lab tests may be reimbursed separately if billed correctly.

Q4. How often can MAT follow-up visits be billed?

Frequency limits depend on payer rules, with some allowing weekly or biweekly billing.