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Opioid Treatment Programs (OTPs) Medicare Enrollment Fact Sheet Opioid Treatment Programs (OTPs) Med 2026
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How many OT sessions does Medicare cover?
Medicare covers occupational therapy if its medically necessary and your doctor recommends the services. There is no limit on how many occupational therapy sessions Medicare will cover.
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.
Does Medicare cover opioid treatment?
Medicare covers Opioid Use Disorder (OUD) treatment services for people with Medicare when you get them from a doctor or other health care practitioner, or through a more comprehensive Opioid Treatment Program (OTP).
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
Does Medicare cover maintenance occupational therapy?
Medicare does cover services to maintain or manage a beneficiarys current condition when no functional improvement is possible if the services are medically necessary and meet the skilled care requirements.
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What is an OTP medicine?
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).
Related links
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