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Home Resources Medicaid Billing for OASAS Services

Methadone Treatment

NOTE: APG Implementation Information: Providers that operate OASAS-Certified Methadone (Opiate) Treatment Programs will convert to APG Medicaid Billing.   However, until such conversions take effect, providers will continue to bill for Medicaid using the rate codes and reimbursement amounts listed below.

Medicaid Fee for Service Fees and Rate Codes

Article 28 (Department of Health)

Service Rate Code1 D&TC Clinic Fee/Rate Hospital Rate/Fee
MTP
1671
$138.002
[weekly fee]
N/A
MTP
2973
N/A
$138.002
[weekly fee]
MTP - Article 33 Physician Services, Procedure Code H0020, Weekly Fee $59.15

1Rate Code: code assigned by the New York State Department of Health to indicate the Medicaid FFS reimbursement amount for a billable unit of service associated with the specific rate code

2 Effective April 1, 2008

Other Information

Applicable OASAS and Other Relevant Regulations specific to operating a Methadone Treatment Program

828 Chemotherapy Substance Abuse Programs – OASAS regulations to operate a Methadone Treatment program

829 Authorization for Physicians to Use Controlled Substances for Treatment of Chemical Dependence – Applies to any physician who dispenses, administers, delivers or prescribes a controlled substance, other than methadone, to a chemically dependent individual for maintenance or detoxification treatment purposes in New York State.

http://public.leginfo.state.ny.us/menugetf.cgi – Article 28 of the NY Public Health Law - New York State Hospital Operation Requirements

Federal regulations addressing the Certification of Opioid Treatment Programs

DEA Forms for those applying to DEA for a controlled substance registration

Buprenorphine – Additional information for the provision of Buprenorphine. New Information

Title 10 NYCRR Part 80.84 authorizes the use of Buprenorphine, a controlled substance, to treat chemically dependent individuals.

829 Authorization for Physicians to Use Controlled Substances for Treatment of Chemical Dependence – Applies to any physician who dispenses, administers, delivers or prescribes a controlled substance , other than methadone, to a chemically dependent individual for maintenance or detoxification treatment purposes in New York state.

Medicaid Managed Care and Family Health Plus

Medicaid Managed Care (MAMC)
contract: defines enrollee benefit package

Methadone Treatment provided by OASAS certified facilities that provide methadone are not a covered benefit for MAMC enrollees. For all MAMC enrollees this service is a “carved out benefit” and available through Medicaid FFS. MTP may be billed through Medicaid FFS.

Family Health Plus (FHPlus ) contract: defines enrollee benefit package

Methadone Treatment provided by OASAS certified facilities is not a plan covered benefit for FHPlus. FHPlus plans are not responsible for MTP and FHPlus clients are not eligible for Medicaid FFS.

Special Policies: impacting delivery of Methadone Treatment services to MAMC and FHPlUS enrollees

Court Ordered Services – Generally, plans must provide court ordered benefit package services.

Welfare Reform – Medically Supervised Inpatient/Outpatient Withdrawal may be ordered by the Local Service Services District.