Status Update of OASAS Opioid Treatment Program (OTP) Bundles to Ambulatory Patient Groups (APG) Methodology
Impacted Plans: Mainstream Medicaid Managed Care Plans, Health and Recovery Plans (HARPs), HIV Special Needs Plans (HIV SNPs), and Medicaid Advantage Plus (MAP) Plans
TO: ALL OASAS Opioid Treatment Programs
Dear MetroPlusHealth Provider,
Effective July 1 – Nov. 3, 2024, providers have the option of billing for the Opioid Treatment Program (OTP) bundled services under either the existing OTP bundle rate codes (7969-7976) or under APG methodology.
Effective November 4, 2024, OTP providers should only bill the bundle services under the APG methodology. Claims will be denied if billed with OTP bundled rate codes (7969 – 7976).
OASAS Guidance – OTP Bundle rates to APG:
Effective November 4, 2024, to allow reimbursement of OTP bundle services billed under APG methodology, OTP programs should bill CPT codes G2067, G2068, G2078 or G2079.
Providers may also bill substance use disorder (SUD) services that fall outside of the OTP bundle on the same APG claim, billed weekly.
This change will also allow providers who offer services in the community, including mobile medication units, to bill the bundles under APG rate code 1088 and receive the enhanced reimbursement.
