Wiki Medicare SUD coding debate

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jsmith97402

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G2067 and G 2078 are to be billed as weekly bundled services, Correct? My Manager says it's fine to bill by dose. I've shown her the CMS OTP fee schedule but she refuses to correct claims prior to submission. I am not wrong am I? Thank you very much for your time and a quick response please.
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For an approved OTP provider - g2067 is the weekly bundled rate which includes the medication. G2078 is the additional -up to a 7 day supply that can be billed . You cannot bill the G2078 more than 3 units per month. Billing can look like this monthly ( 4 weeks) , provided the services were given:
Week 1 G2067
G2078 x 3
week 2 g2074
week 3 g2074
week 4 g2074
or
week 1 G2067
G2078 x1
week 2 G2067
week 3 G2067
week 4 G2074
 
claudineerie@hotmail.com said:
For an approved OTP provider - g2067 is the weekly bundled rate which includes the medication. G2078 is the additional -up to a 7 day supply that can be billed . You cannot bill the G2078 more than 3 units per month. Billing can look like this monthly ( 4 weeks) , provided the services were given:
Week 1 G2067
G2078 x 3
week 2 g2074
week 3 g2074
week 4 g2074
or
week 1 G2067
G2078 x1
week 2 G2067
week 3 G2067
week 4 G2074
Click to expand...
Hello,
Question can G2074 be billed even though the patient is self administering meds at home?
 
To bill Medicare for the G codes you must be a Medicare enrolled OTP provider then you MUST use the bundled codes per MLN8296732. We have a lot of clients/patients that we bill for this service. If they dose daily or have a 1 week take home we bill G2067 or G2068 (meth/buph) It is billed each week with the dos as a sunday usually...i think it makes it easier doing it that day. (ie 01/29/2023-G2067 (1 unit), 02/05/2023-G2067 (1 unit)) If the client has a two week take home of methadone we bill G2067 & G2078 (bundle with medication/extra 7 days of medication) every two weeks. If they come in the week in between and have counseling, UDS or group then you bill G2074 (bundle with no medication) but only if they have services..if they do not come in for any services then you bill nothing that week.
So my billing would look like this for daily or weekly dosing:
01/08/2023 G2067 1 unit (this includes counseling, uds, group, etc) if they have a dr appt you can bill a G2077 as an add on code
01/15/2023 G2067 1 unit
01/22/2023 G2067 1 unit

Billing for a two week take home dosing:
01/08/2023 G2067 & G2078 1 unit each
01/15/2023 no services nothing billed
01/22/2023 G2067 & G2078 1 unit each
01/31/2022 G2074 (client had group and individual counseling)
 

Attachments

  • MLN8296732 Opioid Treatment Programs (OTPs) Medicare Billing & Payment Booklet.pdf
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dvarn567 said:
To bill Medicare for the G codes you must be a Medicare enrolled OTP provider then you MUST use the bundled codes per MLN8296732. We have a lot of clients/patients that we bill for this service. If they dose daily or have a 1 week take home we bill G2067 or G2068 (meth/buph) It is billed each week with the dos as a sunday usually...i think it makes it easier doing it that day. (ie 01/29/2023-G2067 (1 unit), 02/05/2023-G2067 (1 unit)) If the client has a two week take home of methadone we bill G2067 & G2078 (bundle with medication/extra 7 days of medication) every two weeks. If they come in the week in between and have counseling, UDS or group then you bill G2074 (bundle with no medication) but only if they have services..if they do not come in for any services then you bill nothing that week.
So my billing would look like this for daily or weekly dosing:
01/08/2023 G2067 1 unit (this includes counseling, uds, group, etc) if they have a dr appt you can bill a G2077 as an add on code
01/15/2023 G2067 1 unit
01/22/2023 G2067 1 unit

Billing for a two week take home dosing:
01/08/2023 G2067 & G2078 1 unit each
01/15/2023 no services nothing billed
01/22/2023 G2067 & G2078 1 unit each
01/31/2022 G2074 (client had group and individual counseling)
Click to expand...
Thank you!
 
dvarn567 said:
To bill Medicare for the G codes you must be a Medicare enrolled OTP provider then you MUST use the bundled codes per MLN8296732. We have a lot of clients/patients that we bill for this service. If they dose daily or have a 1 week take home we bill G2067 or G2068 (meth/buph) It is billed each week with the dos as a sunday usually...i think it makes it easier doing it that day. (ie 01/29/2023-G2067 (1 unit), 02/05/2023-G2067 (1 unit)) If the client has a two week take home of methadone we bill G2067 & G2078 (bundle with medication/extra 7 days of medication) every two weeks. If they come in the week in between and have counseling, UDS or group then you bill G2074 (bundle with no medication) but only if they have services..if they do not come in for any services then you bill nothing that week.
So my billing would look like this for daily or weekly dosing:
01/08/2023 G2067 1 unit (this includes counseling, uds, group, etc) if they have a dr appt you can bill a G2077 as an add on code
01/15/2023 G2067 1 unit
01/22/2023 G2067 1 unit

Billing for a two week take home dosing:
01/08/2023 G2067 & G2078 1 unit each
01/15/2023 no services nothing billed
01/22/2023 G2067 & G2078 1 unit each
01/31/2022 G2074 (client had group and individual counseling)
Click to expand...

Regarding G2074- What if the pt sees provider for an office visit to prescribe Buprenorphine (not administered or dispensed in office) and received individual counseling same week. Our OTP is Medicare enrolled and for our buprenorphine patients, we are billing office visits (99213) because the pt sees doctor and doc sends Rx to pharmacy. We do not dispense or administer buprenorphine in office. I'm trying to see if we should be billing G2074 instead of office visits. Any input would be greatly appreciated!
 
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