New Telehealth Codes Proposed for Opioid Use Disorder


Healthcare providers who use telemedicine to treat patients for substance abuse could receive improved Medicare reimbursement in 2020 if recently announced recommendations from the Centers for Medicare & Medicaid (CMS) are adopted.
https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-2
As part of its proposed 2020 Physician Fee Schedule rule, CMS said it wants to add new codes for telehealth treatment for opioid use disorders. The HCPCS codes GYYY1, GYYY2, and GYYY3, describe a bundled episode of care for treatment.

The following is a breakdown of those codes:

  • HCPCS code GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.
  • HCPCS code GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.
  • HCPCS code GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

The new codes are part of an overall move to address growing concerns about increasing numbers of drug overdose deaths.

On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.

Section 2005 of the SUPPORT Act created a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs).

To meet this statutory requirement, CMS is proposing:

  • Definitions of OTP and OUD treatment services
  • Enrollment policies for OTPs
  • Methodology and estimated bundled payment rates for OTPs that vary by the medication used to treat OUD and service intensity, and by full and partial weeks
  • Adjustments to the bundled payments rates for geography and annual updates
  • Flexibility to deliver the counseling and therapy services described in the bundled payments via two-way interactive audio-video communication technology as clinically appropriate
  • Zero beneficiary copayment for a time limited duration.

CMS said it plans to implement this benefit beginning January 1, 2020, as required by the SUPPORT Act.

CMS is soliciting comments on the proposed telehealth rule. Commenters have until 5:00 p.m. September 27, 2019 to do so by clicking on this link.
https://www.regulations.gov/docket?D=CMS-2019-0111

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