KMAP BULLETIN: Medication Assisted Treatment – Office Based Opioid Treatment (OBOT) Programs
Date: 09/25/20
KMAP GENERAL BULLETIN 20191 (PDF)
Effective October 1, 2020 through September 30, 2025, all Medication Assisted Treatment (MAT) drugs and biological products, used for Opioid Use Disorder (OUD) will be covered. All MAT drugs and biologicals billed through the medical benefit require a diagnosis code to be considered for payment.
Medications Covered:
MAT drugs, excluding Methadone, will be covered for Office-based Opioid Treatment (OBOT), according to the inclusions and exceptions listed below. Methadone used for MAT is only covered in an Opioid Treatment Program (OTP) setting. MAT drugs used for OUD are considered Part B drugs, per Medicare guidelines. Covered drugs and biological products approved for OBOT are listed below and providers should follow the laws and guidelines for providing OBOT. More information can be found here.
- Buprenorphine products indicated for MAT are the following:
- Buprenorphine brand products and their associated generics:
- Buprenorphine sublingual tablets (Subutex)
- Buprenorphine/naloxone sublingual films (Suboxone)
- Buprenorphine/naloxone) sublingual tablets (Zubsolv)
- Buprenorphine/naloxone buccal film (Bunavail)
- Buprenorphine implants (Probuphine)
- Buprenorphine extended-release injection (Sublocade)
- Naltrexone brand products and their associated generics:
- Naltrexone tablets (Depade, Revia)
- Naltrexone injection (Vivitrol)
Buprenorphine products that are indicated for pain, such as Belbuca, Butrans, and Buprenex, should not be prescribed for MAT.
Physicians, nurse practitioners, physician assistants, and qualified mid-level practitioners approved by Substance Abuse and Mental Health Services Administration (SAMHSA), with a Drug Addiction Treatment Act of 2000 (DATA 2000) waiver may dispense or prescribe any Controlled Substances Act (CSA) scheduled III, IV, V medication approved by the FDA for the treatment of Opioid Use Disorder (OUD). More information can be found here.
From October 1, 2018 and ending on October 1, 2023, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives are included in the provider types approved for MAT services, per the 2018 SUPPORT Act. More information can be found here.
Pharmacists will be required to validate that the providers are DATA 2000 waivered. More information can be found here.
Claims may be audited. Those found to have a Non-DATA 2000 Waiver provider, may be recouped.
Services covered:
The 2018 SUPPORT Act requires counseling and behavioral therapy to be part of a MAT program. Coordination of these services is necessary to ensure services are rendered and proper billing occurs. Compliance with the K.S.A. 39-708c, 65-4016, and 65-4607. “Standards for Licensure/Certification of Alcohol and/or Other Drug Abuse Treatment Programs” R03—711, Section K, regarding counseling requirements is required.
- 80348
- H0001
- H0004
- H0005
- H0005 U5
- H0006
- H0006 U5
- H0007
- H0015
- H0015 U5
- J0570
- J0571
- J0572
- J0573
- J0574
- J0575
- J2315
- Q9991
- Q9992
- G2086
- G2087
- G2088
* J0592 refers to buprenorphine injections for pain only, not OUD.
For presumptive and definitive urine drug screens, no more than 24 tests cumulative per patient per rolling year will be allowed from the same MAT provider. CODES: 80348 and 80358.
Medication use counseling for OUD medications that are provided by pharmacists are not included as part of OBOT services.
Current rules for other health insurance apply. Providers of this type of service are required to bill claims to primary insurance, if applicable.
All licensures must be in accordance with Medicare standards.
Note: The effective date of the policy is October 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.