Wiki Take home Prep Fee for Opioid Treatment Programs

[stephaniefreeman1986@yahoo.com]

Good afternoon,

I would like to know the following:
a provider is billing a G2067 for Medicare clients with an Add-On Code of G2078 where applicable. In the description for the G2067 it already states ‘weekly bundle including dispensing or/and administering…’.
Can the provider have all clients sign an ABN to cover an additional Take-Home PREP FEE that is paid out of pocket by the client and not bill Medicare, but just straight out bill the client for this?
I thought the cost of the dispensing of a take-home fee would already be covered by those two above mentioned codes?

Thank you for any help.

 

[sls314]

Good afternoon,

I would like to know the following:
a provider is billing a G2067 for Medicare clients with an Add-On Code of G2078 where applicable. In the description for the G2067 it already states ‘weekly bundle including dispensing or/and administering…’.
Can the provider have all clients sign an ABN to cover an additional Take-Home PREP FEE that is paid out of pocket by the client and not bill Medicare, but just straight out bill the client for this?
I thought the cost of the dispensing of a take-home fee would already be covered by those two above mentioned codes?

Thank you for any help.

I agree with you. The G2078 and G2067 are a bundled service for the weekly treatment. The definition of the codes already includes a take home supply.

This isn't my area of expertise. However, it seems clear after reading the code descriptions and the MLN document "Opioid Treatment Programs Medicare Billing & Payment" https://www.cms.gov/files/document/otp-billing-and-payment-fact-sheet.pdf