Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 444.00 - Rates for Certain Substance Use Disorder Services › Section 444.04 - Rate Provisions

Current through Register 1525, July 5, 2024
(1)
Services Included in the Rate
. The approved rate
			 includes payment for all care and services that are part of the program of
			 services of an eligible provider, as explicitly set forth in the terms of the
			 purchase agreement between the eligible provider and the purchasing
			 governmental unit(s).
(2)
Rates as Full Payment
. Each eligible provider must, as
			 a condition of acceptance of payment made by any purchasing governmental units
			 for services rendered, accept the approved program rate as full payment and
			 discharge of all obligations for the services rendered. Payment from any other
			 sources is used to offset the amount of the purchasing governmental unit's
			 obligation for services rendered to the publicly assisted client.
(3)
Payment
			 Limitations
. No purchasing governmental unit may pay less than or
			 more than the approved program rate except as provided in
			 101
			 CMR 444.04(2).
(4)
Approved Program
			 Rates
. The rate of payment for authorized services is the lower of
			 the established charge or rate listed below. Refer to purchasers' manuals for
			 special coding instructions and limitations on number of units.
Code
Rate
Unit
Description
G2067
$190.82
Per Week
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)
G2068
$227.96
Per Week
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)
G2073
$1,209.57
Per Week
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)
G2074
$149.34
Per Week
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)
G2076
$165.73
Per Initial Visit
Intake activities, including initial medical
							 examination that is a complete, fully documented physical evaluation and
							 initial assessment by a program physician or a primary care physician, or an
							 authorized healthcare professional under the supervision of a program physician
							 or qualified personnel that includes preparation of a treatment plan that
							 includes the patient's short-term goals and the tasks the patient must perform
							 to complete the short-term goals; the patient's requirements for education,
							 vocational rehabilitation, and employment; and the medical, psycho-social,
							 economic, legal, or other supportive services that a patient needs, conducted
							 by qualified personnel (provision of the services by a Medicare-enrolled Opioid
							 Treatment Program); list separately in addition to code for primary
							 procedure
G2078
$31.77
Per Week
Take-home supply of methadone; up to seven additional
							 day supply (provision of the services by a Medicare-enrolled Opioid Treatment
							 Program); list separately in addition to code for primary
							 procedure.
G2079
$68.92
Per Week
Take-home supply of buprenorphine (oral); up to seven
							 additional day supply (provision of the services by a Medicare-enrolled Opioid
							 Treatment Program); list separately in addition to code for primary
							 procedure.
H2015-HF
$17.09
Per 15 Minutes
Comprehensive community support services, per 15
							 minutes (Recovery Support Navigator)
H2036 - HK
$766.01
Per Diem
Alcohol and/or other drug treatment program,
per diem
(Individualized Treatment and Stabilization, Tier
							 1)
H2036 - HF
$556.02
Per Diem
Alcohol and/or other drug treatment program,
per diem
(Individualized Treatment and Stabilization, Tier
							 2)