Opioid treatment program (OTP)
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Spotlight
OTPs provide medication-assisted treatment for people diagnosed with an opioid use disorder (OUD). Medicare Part B will reimburse services provided under this program through a bundled payment methodology. This includes medication-assisted treatment medications, toxicology testing and counseling.
Medicare Part B covers OTP services at freestanding OTP facilities and hospital outpatient departments. As an OTP, you can enroll as a Part A or a Part B provider. For additional information on enrollment see the Opioid Treatment Program Enrollment Page.
- Behavioral health services
Medicare covers behavioral, mental and psychiatric health services that may improve outcomes for Medicare patients. For more information, please view this article and share these valuable resources and references with your patients. - Intensive outpatient program
IOP is a distinct and organized outpatient program of psychiatric services provided for individuals who have an acute mental illness or qualified conditions, including substance use disorders. IOP services may be furnished in Opioid Treatment Programs (OTPs) for the treatment of opioid use disorder (OUD).
Education
- Prevent errors on your OTP claims
- Enrolling as an Opioid Treatment Program provider in Medicare
- How to bill Medicare as an Opioid Treatment Program provider
Resources
- Visit the OTP webpage on CMS’ website for additional information.
- OTP enrollment webpage
- OTPs Medicare enrollment fact sheet
- OTP billing and payment webpage
- OTPs Medicare billing and payment fact sheet
- CMS IOM Pub. 100-02, Medicare Benefit Policy Manual, chapter 17
- CMS IOM Pub. 100-04, Medicare Claims Processing Manual, chapter 39
- Medicare and Mental Health Coverage
- Substance Use Screenings and Treatment
- A Prescriber’s Guide to Medicare Prescription Drug (Part D) Opioid Policies
- OIG Report - OEI-02-23-00360 - Not All Medicare Enrollees Are Continuing Treatment for Opioid Use Disorder
- MLN Connects Newsletter for June 11, 2026: Opioid Treatment Programs: CY 2026 Updates
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