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30.6  Coding  (Rev. 12418; Issued: 12- 21-23; Effective: 01 -01-24; Implementation: 01- 24-24)  The codes describing bundled payments made to OTPs are HCPCS codes G2067- G2075. There are add- on codes described by HCPCS codes G2076- G2080, HCPCS codes G2215, G2216, G1028, and G0137 . Only an entity enrolled with Medicare as an OTP can bill these codes. Additionally, OTPs are limited to billing only these codes describing bundled payments, and may not bill for other codes, such as those paid under the PFS.   The coding structure for OUD treatment services varies by the medication administered. There are G codes for weekly bundles describing treatment with methadone, oral buprenorphine, injectable buprenorphine, buprenorphine implants (insertion, removal, and i nsertion/removal), extended- release injectable naltrexone, a non- drug bundle, and one for a medication not otherwise specified (see full list of codes below).   The code describing the bundled payment for an episode of care with a medication not otherwise specified (HCPCS code G2075) should be used when the OTP furnishes MAT with a new opioid agonist or antagonist treatment medication approved by the FDA under sec tion 505 of the FFDCA for the treatment of OUD. OTPs may use this code until CMS has the opportunity to propose and finalize a new G code to describe the bundled payment for treatment using that drug and price it accordingly in the next rulemaking cycle.   HCPCS code G2075 should not be used when the drug being administered is not a new opioid agonist or antagonist treatment medication approved by the FDA under section 505 of the FFDCA for the treatment of OUD, and therefore, for which Medicare would not have the authority to make payment since section 1861(jjj)(1)(A) of the Act requires that the medication must be an opioid agonist or antagonist treatment medication approved by the FDA under section 505 of the FFDCA for the treatment of OUD.   HCPCS code G2074, which describes a non- drug bundle, can be billed for services furnished during an episode of care when a medication is not administered, but other services in the bundle are furnished. For example, when a patient receives a buprenorphine injection on a monthly basis, the OTP will only require payment for the medication during the first week of the month when the injection is given, and therefore, would bill the code describing the bundle that includes injectable buprenorphine during the first week of the month and would bill the code describing the non- drug bundle for the remaining weeks in that month for services such as substance use counseling, individual and group therapy, and toxicology testing.   NOTE: Some of the bundled payment codes describe a drug that is typically only administered once per month, such as the injectable drugs, or once in a 6 -month period, in the case of the buprenorphine implants. In those cases, the code describing the bundled payment that includes the cost of the drug would be billed during the week that the drug is administered, and if at least one service is furnished in a subsequent week, the non- drug bundle would be billed. For example, in the case of a patient receiving injectable buprenorphine, CMS would expect that HCPCS code G2069 would be billed for the week during which the injection was administered and that HCPCS code G2074, which describes a bundle not including the drug, would be bil led during any subsequent weeks that at least one non- drug service is furnished until the injection is administered again, at which time HCPCS code G2069 would be billed again for that week.   CMS notes that as HCPCS codes G2067  G2075, and G0137, cover episodes of care of 7 contiguous days, CMS will not permit an OTP to bill any of these codes for the same beneficiary more than once per 7 contiguous day period. Additionally, consistent with FDA labelling, CMS does not generally expect the codes d escribing bundled payments including the injectable drugs (HCPCS codes G2069 and G2073) to be furnished more than once every 4 weeks. Similarly, consistent with FDA labelling, CMS does not generally expect the codes describing bundled payments including insertion of the buprenorphine implants (HCPCS codes G2070 and G2072) to be furnished more than once every 6 months.   CMS understands there are limited clinical scenarios when a beneficiary may be appropriately furnished OUD treatment services at more than one OTP within a 7 contiguous day period, such as for guest dosing or when a beneficiary transfers care between OTPs.  In these limited circumstances, each of the involved OTPs may bill the appropriate HCPCS codes that reflect the services furnished to the beneficiary. CMS expects that both OTPs involved would provide sufficient documentation in the patients medical record to reflect the clinical situation and services provided. Additionally, in instances in which a patient is switching from one drug to another, the OTP should only bill for one code describing a weekly bundled payment for that week and should determine which code to bill based on which drug was furnished for the majority of the week.    30.6.1 - Adjustments to Bundled Payment Rate  (Rev. 12418; Issued: 12- 21-23; Effective: 01 -01-24; Implementation: 01- 24-24)  There are add -on codes for intake activities, periodic assessments, take- home supplies of methadone, take home  supplies  of oral buprenorphine, additional  counseling or therapy  services  furnished, and  for take-home supplies of naloxone.  CMS  notes  that the add-on code  describing intake  activities  (HCPCS  code  G2076)  should only be billed  for new patients (that is, patients starting treatment at the OTP).   There are two add -on codes that describe take- home doses of medication, one for take -home supplies of methadone (HCPCS code G2078), which describes up to 7 additional days of medication, and can be billed along with the respective weekly bundled payment in units of up to 3 (for a total of up to a one month supply), and one for take -home supplies of oral buprenorphine (HCPCS code G2079), which also describes up to 7 additional days of medication and can be billed along with the base bundle in units of up to 3 (for a total of up to a 1 month supply). SAMHSA allows a maximum take -home supply of one month of medication;  therefore,  CMS  does not expect  the add-on codes  describing take- home  doses  of methadone  and oral buprenorphine to be billed any more than 3 times in one month (in addition to the weekly bundled payment). The add- on code  for take -home  doses of  methadone  can only be used with the  methadone weekly episode of care code (HCPCS code G2067). Similarly, the add- on code for take -home doses of oral buprenorphine can only be used with the oral buprenorphine weekly episode of care code (HCPCS code G2068).   HCPCS code G2080 may be billed when counseling or therapy services are furnished that substantially exceed  the amount  specified  in the patients  individualized treatment  plan. OTPs  are required  to document the medical necessity for these services in the patients medical record.   OTPs billing for intensive outpatient services (G0137) must be furnishing these services as part of a distinct and organized intensive ambulatory treatment program for the treatment of Opioid Use Disorder, and as part of a program that offers less than 24- hour daily care other than in an individual's home or in an inpatient or residential setting. By billing G0137, OTPs are attesting that these intensive outpatient services are reasonable and necessary for the diagnosis or active treatment of the individual 's condition; are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization; and are furnished in accordance with a physician or non- physician practitioner (as defined in section 1842(b)(18)(C) of the Act) certification and plan of care, as permitted by State law and scope of practice requirements. A physician or non- physician practitioner must certify that the individual has a need for a minimum of nine hours of services per week and requires a higher level of care intensity compared to other non- intensive outpatient OTP services. FDA -approved opioid agonist or antagonist medications for the treatment of OUD, opioid antagonist medications for the emergency treatment of known or suspe cted opioid overdose, or toxicology testing, do not count as payable OTP intensive outpatient services but if rendered, should be billed using existing bundles and/or add-on codes as long as all other applicable requirements are met.   The codes and  long descriptors  for the OTP  bundled services  and add-on services  are:   HCPCS code G2067: Medication assisted treatment, methadone; weekly bundle including dispensing and/or  administration,  substance  use counseling, individual  and group therapy, and toxicology testing,  if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS code G2068: Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or  administration,  substance  use counseling, individual  and group therapy, and  toxicology testing if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS  code  G2069:  Medication  assisted  treatment,  buprenorphine  (injectable);  weekly  bundle  including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS  code  G2070:  Medication  assisted  treatment,  buprenorphine  (implant insertion);  weekly  bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS  code  G2071:  Medication  assisted  treatment,  buprenorphine  (implant removal);  weekly  bundle including dispensing and/or  administration,  substance  use counseling, individual  and group therapy, and toxicology testing if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS code G2072: Medication assisted treatment, buprenorphine (implant insertion and removal); weekly  bundle  including dispensing and/or  administration,  substance  use counseling, individual  and group therapy, and toxicology testing if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).   HCPCS code G2073: Medication assisted treatment, naltrexone; weekly bundle including  dispensing and/or  administration,  substance  use counseling, individual  and group therapy, and toxicology testing  if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS code G2074: Medication assisted treatment, weekly bundle not including the drug, including substance  use counseling, individual  and group therapy, and toxicology testing  if performed  (provision of the services by a Medicare- enrolled Opioid Treatment Program).    HCPCS  code  G2075:  Medication  assisted  treatment,  medication  not otherwise  specified;  weekly  bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare -enrolled Opioid Treatment Program).    HCPCS code G0137: Intensive outpatient services; minimum of nine services over a 7 - contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under State law); occupational therapy requiring the skills of a qualified occupational therapist; services of social  workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; drugs and biologicals furnished for therapeutic purposes, excluding opioid agonist and antagonist medications that are FDA -approved for use in treatment of OUD or opioid antagonist medications for the emergency treatment of known or suspected opioid overdose; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individuals condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individuals care and treatment); diagnostic services (not including toxicology testing); (provision of the services by a Medicare -enrolled Opioid Treatment Program); List  separately in addition to code for primary procedure, if applicable