Wiki New G codes to bundle opioid use disorder treatment

[reddaway@sbcglobal.net]

Are the new bundled G codes (G2086, G2087 & G2088) for OUD treatment ONLY for telehealth services or for use in office setting also?

 

[jkyles]

Hi there. It's both.

The codes are listed as telehealth services and the originating site for an OUD treatment can be the patient's home. Here's the complete list of telehealth services for 2020 (and 2019): https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

However, CMS says this (emphasis added):

Bundled Payments under the PFS for Opioid Use Disorders

A bundled payment for the management and counseling for OUD, will create an avenue for clinicians to bill for a group of services in the office setting similar to the services being paid for under the new OTP benefit for opioid treatment program clinics. CMS is finalizing the creation of new coding and payment for a monthly bundle of services for the treatment of OUD that includes overall management, care coordination, individual and group psychotherapy, and substance use counseling, as well as an add-on code for additional counseling. The individual psychotherapy, group psychotherapy, and substance use counseling included in these codes could be furnished as Medicare telehealth services using communication technology as clinically appropriate. CMS will consider coding and payment amounts that recognize different levels of patient need and different types of practice arrangements for future rulemaking, including use of MAT in the emergency department setting.

 

[reddaway@sbcglobal.net]

Thank you very much. That's what I thought but wanted to be sure.

 

[mdandh]

Hi there. It's both.

The codes are listed as telehealth services and the originating site for an OUD treatment can be the patient's home. Here's the complete list of telehealth services for 2020 (and 2019): https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

However, CMS says this (emphasis added):

Hello, I saw this thread and have a question on billing for opioid tx. I have a psychiatrist that is providing these services now. He is seeing Medicaid and Caresource and Med Advantage patients. Do you know the CPT to use for biling OTP? It is for office visit not telehealth. I just tagged on this forum I found. Thank you

 

[spalac4@wgu.edu]

Hi there. It's both.

The codes are listed as telehealth services and the originating site for an OUD treatment can be the patient's home. Here's the complete list of telehealth services for 2020 (and 2019): https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

However, CMS says this (emphasis added):

Hi there,
Do you know if case management can be included to G2086/ G2087 or G2088?

 

[dvarn567]

I would think Case Management would be included as it is included in our OTP G codes.
Office-Based Treatment Substance Use Disorder (SUD) bundled services
G2086Office-based treatment for substance use disorder, including treatment plan development, care coordination, therapy and counseling; at least 70 minutes in the first calendar month Monthly bundled service for SUD treatment services provided in office or via telehealth
G2087Office-based treatment for substance use disorder, including care coordination ,therapy and counseling; at least 60 minutes in a subsequent month Monthly bundled service for SUD treatment services provided in office or via telehealth+
G2088Office-based treatment for substance use disorder, including care coordination, therapy and counseling; each additional 30 minutes beyond the first 120 minutes;Q3014 Telehealth originating site facility fee (facility where patient is sitting)This code cannot be billed when the originating site is the member’s home.
Office-Based Treatment Substance Use Disorder (SUD) bundled services Notes; G2086 and G2087 codes are monthly bundled SUD treatment services representing plan development, care coordination and therapy services provided in the office or via telehealth. These codes should not be billed for members receiving MAT services at an OTP. CMS allows G2086, G2086 and G2087 to be provided via telehealth or as audio-only when the member does not have access to two-way audio-visual communication technology or did not consent to its use. Modifiers: Providers billing the G2086, G2087 and G2088 services should insert the appropriate license level modifier in the first modifier field, and if the service is provided via telehealth or audio-only services, the telehealth modifier (GT or 95) or audio-only modifier (FQ or 93) in the second modifier field. Place of service (POS) codes: All telehealth or audio-only services submitted on an 837p transaction or CMS 1500 form mustinclude the appropriate telehealth POS code:a. Telehealth or audio-only services provided when the member is located in their home should be billed with POS code 10.

 

[jkyles]

Hi there,
Do you know if case management can be included to G2086/ G2087 or G2088?

Hi, just to clarify - do you mean case management or carte management?