Opioid Treatment Programs (OTPs)
Opioid Treatment Programs (OTPs) provide medication-assisted treatment (MAT) through bundled payments for Opioid Use Disorder (OUD) treatment services (PDF) for people diagnosed with an opioid use disorder (OUD). OTPs must be certified by SAMHSA and accredited by an independent, SAMHSA-approved accrediting body.
Refer to CMS’s OTP webpage for enrollment, coding, and claims information.
Under the OTP benefit, Medicare covers:
- U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
- Dispensing and administration of MAT medications (if applicable)
- Take-home supply of methadone, oral buprenorphine, nasal naloxone and injectable naloxone
- Substance use counseling
- Individual and group therapy
- Toxicology testing
- Intake activities
- Periodic assessments
- Intensive oupatient program services
Opioid Treatment Program requirements:
1. Get certified/accredited: OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent, SAMHSA-approved accrediting body. For SAMHSA certification, OTPs must comply with all pertinent state laws and regulations, and all regulations enforced by the Drug Enforcement Administration. For more information on the accreditation process, visit SAMHSA’s Certification of Opioid Treatment Programs (OTPs) webpage.
2. Get enrolled: Certified, accredited providers must enroll in Medicare to bill OTP services under Medicare Part B. Refer to the OTP Medicare Enrollment Fact Sheet (PDF) to learn more about the enrollment process and the documentation you’ll need to get started.
3. Get contracted: Medicare-enrolled OTPs must contract with Magellan to serve Medicare Advantage plans that we manage. If you are already contracted with Magellan for the Medicare network, then you’ll need to have your contract amended to add the OTP services. If you are not already contracted with Magellan for the Medicare network, you’ll need to complete the Medicare enrollment process first and then complete the credentialing and contracting process to become an in-network provider for OTP services.
Magellan’s next steps
Magellan covers the OTP services for members of our Medicare Advantage and dual-eligible behavioral health plans. To contract with Magellan for OTP services to these members, contact your field network representative to learn more. If you’re unsure who your field network representative is, contact our Provider Services Line at 1-800-788-4005.