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3 https://www.narcan.com/static/Gen2 -Prescribing -Information.pdf  4 http://labeling.pfizer.com/ShowLabeling.aspx?id=4541 5 https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f0932877- 1f3b- 4d5e -82d2- dd6c53db4730&type=display.      40.1.2 - Duplicative Payments Under Parts B or D  (Rev. 11219; Issued: 01- 27-22; Effective: 01 -01-22; Implementation: 03 -01-22)   Section 1834(w)(1) of the Act, added by section 2005(c) of the SUPPORT Act, requires the Secretary to ensure, as determined appropriate by the Secretary, that no duplicative payments are made under Part B or Part D for items and services furnished by an OT P.  Many of the individual items or services provided by OTPs that would be included in the bundled payment rates may also be appropriately available to beneficiaries outside of the OTP benefit. Although CMS recognizes the potential for significant program int egrity concerns when similar items or services are payable under separate Medicare benefits, CMS believes it is important that any efforts to prevent duplicative payments not inadvertently restrict Medicate beneficiaries access to other Medicare benefits even for the time period they are being treated by an OTP.  For example, a beneficiary receiving counseling or therapy as part of an OTP bundle of services may also be receiving medically reasonable and necessary counseling or therapy as part of a physicians service during the same time period.  Similarly, there c ould be circumstances where Medicare beneficiaries with OUD could receive treatment and/or medication from non- OTP entities that would not result in duplicative payments, presuming that both the OTP and the other entity appropriately furnished separate medically -necessary services or items.  Consequently, CMS does not believe that provision of the same kinds of services by both an OTP and a separate provider or supplier would itself constitute a duplicative payment.     However, payment for medications delivered, administered or dispensed to a beneficiary as part of the bundled payment or an adjustment to the bundled payment is considered a duplicative payment if a claim for delivery, administration or dispensing of the s ame medication for the same beneficiary on the same date of service was also separately paid under Medicare Parts B or D. If this occurs, CMS will recoup the duplicative payment made to the OTP.  40.1.3 - Cost Sharing  (Rev. 268: Issued; 02- 14-20: Effective; 01 -01-20: Implementation: 03 -16-20)  The Medicare Part B deductible applies for OUD treatment services, as mandated for all Part B services by section 1833(b) of the Act.   The copayment for OUD treatment services furnished by OTPs under fee -for-service Medicare Part B is set at zero ($0).   50 - Adjustments to Bundled Payment Rates for OUD Treatment Services  (Rev. 268: Issued; 02- 14-20: Effective; 01 -01-20: Implementation: 03 -16-20)  The costs of providing OUD treatment services will likely vary over time and depend on the geographic location where the services are furnished.   50.1 - Locality Adjustment  (Rev. 268: Issued; 02- 14-20: Effective; 01 -01-20: Implementation: 03 -16-20)  Section 1834(w)(2) of the Act, as added by section 2005(c) of the SUPPORT Act, provides that the Secretary may implement the bundled payment for OUD treatment services furnished by OTPs through one or more bundles based on the type of medication provided, the frequency of services, the scope of services furnished, characteristics of the individuals furnished such services, or other factors as the Secretary determines appropriate. The cost for the provision of OUD treatment services, like many other healthca re services covered by Medicare, will likely vary across the country based upon the differing cost in a given geographic locality. Therefore, a geographic locality adjustment will be applied to the bundled payment rate for OUD treatment services as describ ed below:   A. Drug Component   Because pricing for the MAT drugs included in the bundles reflects national pricing, and because there is no geographic adjustment faction (GAF) applied to the payment of Part B drugs under the ASP methodology, there will not be any geographic adjustment t o the drug component of the bundled payment rates.   B.  Non -Drug Component   The GAF will be applied to:   the non- drug component of the OTP bundled payment for OUD treatment, and   the add -on payment adjustments for non- drug services.  50.2 - Annual Update  (Rev. 268: Issued; 02- 14-20: Effective; 01 -01-20: Implementation: 03 -16-20)  A. Drug Component   The drug component of the bundled payment rates will be updated using the most recently available data from the applicable pricing mechanism finalized for drug pricing, as described above, to annually update the drug component of the bundled payment.   B. Non-Drug Component   The non- drug component of the bundled payment for OUD treatment services, and the add- on payments for non-drug services, will be updated based upon the Medicare Economic Index.                            Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#  R12418BP  12/21/2023 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Opioid Treatment Programs (OTPs)  01/24/2024 13470 R11792BP  01/19/2023 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Opioid Treatment Programs and Additional Claims Modifier for Audio -only Services  02/21/2023 13062 R11219BP  01/27/2022 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Opioid Treatment Programs and New Modifier for Audio- only Services  03/01/2022 12545 R10665BP  03/16/2021 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Opioid Treatment Programs (Manual Updates Only)  04/15/2021 12161  02/14/2020 Update to Medicare Benefit Policy Manual and Medicare Claims Processing Manual Adding New Chapters for Opioid Treatment Programs (Manual Updates Only)  03/16/2020 11620 Back to Top of Chapter