MAT Billing

prusso

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Does anyone have any type of MAT billing tools? A clinic in TN is wanting to start Methadone treatment in 2021 with the Medicaid MCO's and I have no guidance for them and how to do their billing. Online searches seem to be very confusing and scattered. Any help would be much appreciated. Thanks
 

SharonCollachi

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Clovis, CA
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Medication Assisted Treatment and Methadone Treatment do not have to be the same thing. Suboxone is actually considered a better drug than methadone for addiction. Both Methadone and Buprenorphine (a component of suboxone) can be prescribed to anyone by any physician for pain; to be prescribed for addiction, methadone MUST be prescribed in a Methadone Clinic; Buprenorphine must be prescribed by a provider that has what is called an "X license" or Data Waiver (their DEA number starts with an X instead of another letter).

How did they get licensed as a methadone provider without knowing how to bill it, or whether it will be financially feasible to start a methadone clinic?? -- Rhetorical question, people do things like this all the time and it blows my mind.

Here is the Medicare information sheet, including codes: https://www.cms.gov/files/document/otp-billing-and-payment-fact-sheet-printer-friendly.pdf

The Medicaid HMO/other programs will have their own billing guides. I would suggest contacting them.
 
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Location
Prospect Park, NJ
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I work for a methadone facility. We usually Bill the codes H0020HF26 which a weekly bundle rate. You can find out more information on what this includes in your State. For NJ the guidelines for us is attached below.
Annex A2 Initiative Specific (rutgers.edu)

Generally on pages 17-18 talks about what requirements are needed to bill for this bundle rate. Not sure if in your state is the same, but this can give you a general idea of some requirement for billing Methadone.
 
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