Medication-Assisted Treatment (MAT) Billing: Coding and Reimbursement

Medication Assisted Treatment (also known as medications for Opioid Use Disorder or MOUD) is the use of medications to treat Opioid Use Disorders (OUDs), such as Buprenorphine or Suboxone. There has never been a reimbursement model for MAT in the emergency department (ED). In response to ACEP advocacy, CMS finalized its proposal to pay for MAT provided in the emergency department beginning in 2021.

Patients may obtain MAT in various settings, such as outpatient physician offices or clinics; opioid treatment programs (OTPs), residential facilities, and hospitals. The proper billing and coding for MAT services are determined by the treatment setting, the services given, and the diagnosis.

Let’s have a look at the coding guidelines related to Medication Assisted Treatment (MAT):

HCPCS Codes

Undoubtedly, accurate coding is critical for claims submitted to third-party payers since incorrect codes can misrepresent the patient care, obstruct research to improve patient care, and result in revenue loss for the hospital. Thereby, HCPCS codes (Healthcare Common Procedure Coding System) are used by Medicaid, Medicare, and other health insurance systems to ensure that insurance claims are processed in an organized and consistent manner. Also, the HCPCS Coding System is required for:

• Hospital payments
• Physician reimbursement
• Quality review
• Measuring benchmarks

The following are the HCPCS codes used for Medication Assisted Treatment (MAT) billing:

G2067: Medication-assisted treatment, methadone;

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7-days

G2068: Medication-assisted treatment, buprenorphine (oral);

• Dos: Use to cover care episodes lasting 7-days in a row and can be billed with buprenorphine combination products (buprenorphine and naloxone) or a buprenorphine-only product
• Don’ts: No billing for the same patient more than once for a period of 7-days

G2069: Medication-assisted treatment, buprenorphine (injectable)

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7 days and no use more than once every four weeks

G2070: Medication-assisted treatment, buprenorphine (implant insertion);

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7 days and no use more than once every six months

G2071: Medication-assisted treatment, buprenorphine (implant removal);

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7-days

G2072: Medication-assisted treatment, buprenorphine (implant insertion and removal);

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7 days and no use more than once every six months

G2073: Medication-assisted treatment, naltrexone;

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7 days and no use more than once every four weeks

G2074: Medication-assisted treatment

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7-days

G2075: Medication-assisted treatment

• Dos: Use to cover care episodes lasting 7-days in a row
• Don’ts: No billing for the same patient more than once for a period of 7-days

Note:

The common list included under all HCPCS codes used for Medication-Assisted Treatment (MAT) billing is as follows:

• Substance use counseling,
• Weekly bundle, including dispensing and/or administration,
• Individual and group therapy, and
• Toxicology testing, if performed

It is also important to note that the HCPCS code G2074 includes a weekly bundle but excludes the drug. Also,  the HCPCS code G2075 has medication not otherwise specified.

Add-on Codes:

• G2076: Intake activities
• G2077: Periodic Assessment
• G2078: Take-home supply of methadone
• G2079: Take-home supply of buprenorphine (oral)
• G2080: Medication-assisted treatment with an additional 30 minutes of counseling in a week
• G2215: Take-home supply of nasal naloxone
• G2216: Take-home supply of injectable naloxone
• G1028: Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 mL nasal spray

Outsource MAT Billing & Coding:

You can also use weekly billing cycles that vary according to the patient. The first day of service will be determined by the day of the week the patient is admitted to the program or when Medicare begins billing. When a patient starts treatment or resumes treatment after a break in treatment, the date of service is the first day you see the patient.

There are many such rules and regulations in Medication-Assisted Treatment (MAT) Billing that are required to be kept in mind to ensure maximum reimbursements. The best approach is to outsource your MAT billing and coding to 24/7 Medical Billing Services to enjoy the benefit of 100% clean claims.