Medicare Codes for Opioid Addiction Treatment via Telehealth coming in 2020

The Centers for Medicare & Medicaid Services(CMS) proposed three new billing codes that should go into effect January 1, 2020 to help combat the opioid epidemic.  These codes will help improve access to opioid addiction treatment through telemedicine encounters.  While the proposed codes are still in their comment period, it is expected that they will be accepted and become an official part of the 2020 Medicare Physician Fee Schedule.

On July 1st of this year CMS removed the usual originating site restrictions that limited where a patient had to be located in order to receive telehealth services for opioid addiction treatment.  Under the prior restrictions, patients generally needed to be located in rural communities and also located within very specific places such as a hospital or medical office but could not be located at home.  With the restrictions lifted patients can receive services by telehealth technologies for substance abuse disorder(SUD) and mental health disorders at the usual locations, but more importantly, they can now receive care in their own home.  

The three newly proposed codes are as follows:

  1. HCPCS GYY1:  Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.
  2. HCPCS GYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy or group therapy and counseling; at least 60 minutes in a subsequent calendar month.
  3. HCPCS GYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

According to a CMS Fact Sheet released July 29, 2019, “CMS is proposing that 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.”  These bundled episodes of care along with the reduced restrictions on the use of telemedicine will help bring much needed care in the form of proven life-saving Medication-Assisted Treatment(MAT) combined with behavioral therapy to underserved regions of the country.