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Opiod Treatment Programs (OTPs) Medicare Enrollment Fact Sheet Opiod Treatment Programs (OTPs) Medic

Opiod Treatment Programs (OTPs) Medicare Enrollment Fact Sheet Opiod Treatment Programs (OTPs) Medic 2025

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The document is a comprehensive fact sheet for Opioid Treatment Programs (OTPs) regarding the Medicare enrollment process. It outlines the necessary steps for OTP providers to enroll in Medicare, including pre-enrollment requirements, application submission procedures, and what to expect after submitting an application. Key topics include gathering required documentation, obtaining a National Provider Identifier (NPI), selecting a billing agency, completing the appropriate enrollment forms (CMS-855A or CMS-855B), and understanding the review process by Medicare Administrative Contractors (MACs). The fact sheet also emphasizes the importance of full certification by SAMHSA and provides resources for further assistance.

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What are the criteria of OTP?

Outpatient Therapeutic Feeding Program (OTP) ing to the protocol for management of SAM, Mid Upper Arm Circumference (MUAC) of less than 110 mms and/or weight-for-height ratio of less than 70% or presence of bilateral pitting edema are the eligibility admission criteria into the OTP.

What is the opioid treatment program for Medicare?

Opioid Treatment Programs (OTPs) provide medications for opioid use disorder (MOUD). OTPs must be certified by SAMHSA and accredited by an independent, SAMHSA-approved accrediting body. We pay OTPs through bundled payments for OUD treatment services for people with Medicare Part B (Medical Insurance).

What are the Medicare OTP billing codes?

Only Medicare-enrolled OTPs can bill for HCPCS codes G2067 through G2080, and G2215 to G2216. All of the drugs that are FDA-approved for the treatment of OUD are currently covered by HCPCS codes G2067-G2073 and G2215 to G2216.

What is the 8 point criteria?

Note: The famous eight points that must be considered for takehomes are: (i) Absence of recent abuse of drugs (opioid or nonnarcotic), including alcohol; (ii) Regularity of clinic attendance; (iii) Absence of serious behavioral problems at the clinic; (iv) Absence of known recent criminal activity, e.g., drug dealing

What are the criteria for admission to OTP?

An OTP shall maintain current procedures designed to ensure that patients are admitted to treatment by qualified personnel who have determined, using accepted medical criteria, that: The person meets diagnostic criteria for a moderate to severe OUD; the individual has an active moderate to severe OUD, or OUD in

What do you need to be an OTP?

OTPs require full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accreditation by a SAMHSA-approved accrediting body. Learn more at SAMHSAs Certification of Opioid Treatment Programs (OTPs) webpage.

What are the criteria for OTP discharge?

You should discharge the child from OTP follow-up if the following criteria are fulfilled: For those who were admitted based on oedema: discharge if there is no oedema for two consecutive visits (14 days) For those who were admitted without oedema: discharge when the child reaches discharge target weight.

Opiod Treatment Programs (OTPs) Medicare Enrollment Fact Sheet Opiod Treatment Programs (OTPs) Medic 2025

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