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Audit of Medicare Part B Opioid-Use-Disorder Treatment Services Provided by Opioid Treatment Programs

Substance use disorders involving drugs or alcohol can cause serious health problems and even death. Medication-assisted treatment is used to treat substance use disorders, including opioid use disorders (OUDs); sustain recovery; and prevent overdoses. There are three medications to treat OUDs: buprenorphine, methadone, and naltrexone, which are approved by the Food and Drug Administration (FDA). Treatment for OUDs is provided in several settings, including freestanding opioid treatment programs (OTPs).

Historically, OTPs could not enroll as providers in Medicare or be paid for services provided to Medicare beneficiaries. Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) established a new Medicare Part B benefit for OUD treatment services furnished by OTPs. CMS implemented this benefit beginning January 1, 2020, as required by the SUPPORT Act. OUD treatment services include FDA-approved treatment medication, dispensing and administration of treatment medication, substance use counseling, individual and group therapy, and toxicology testing.

In this audit, we will focus on claims for OUD treatment services provided by nonresidential (i.e., freestanding) OTPs, which are identified with the place-of-service code 58. We will review OUD treatment services for Medicare beneficiaries in nonresidential OTPs to determine whether the services were allowable in accordance with Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed Centers for Medicare and Medicaid Services Audit of Medicare Part B Opioid-Use-Disorder Treatment Services Provided by Opioid Treatment Programs Office of Audit Services W-00-22-35876;