KMAP BULLETIN: Medicaid Assisted Treatment Rate Update - January 2025
Date: 12/20/24
KMAP GENERAL BULLETIN 24263 (PDF)
Medication Assisted Treatment (MAT) drugs/biologicals that are part of a bundled rate are classified as G-codes under Medicare. These codes will be updated annually, or as often as Centers for Medicare and Medicaid Services (CMS) posts updated MAT G-code rates.
The Medicaid rate for drug-bundled G-codes that include a drug is equal to 100% of the Medicare drug portion of the rate and 65% of the service (non-drug) portion of the rate. The following are the rates effective with dates of service on and after January 1, 2025:
| Code | Medicaid Rate Effective January 1, 2025 |
|---|---|
| G0532 (New code) | $77.33 |
| G0533 (New code) | $557.13 |
| G0534 (New code) | $27.10 |
| G0535 (New code) | $27.10 |
| G0536 (New code) | $27.10 |
| G1028 | $126.89 |
| G0137 | $522.99 |
| G2067 | $189.53 |
| G2068 | $216.51 |
| G2069 | $1,949.56 |
| G2070 | Deleted effective January 1, 2025 |
| G2071 | Deleted effective January 1, 2025 |
| G2072 | Deleted effective January 1, 2025 |
| G2073 | $1,627.81 |
| G2074 | $139.46 |
| G2075 | NOC Code - Manual Pricing |
| G2076 | $148.48 |
| G2077 | $96.16 |
| G2078 | $42.13 |
| G2079 | $69.11 |
| G2080 | $23.40 |
| G2215 | $39.29 |
| G2216 | $12.50 |
Note: The rates noted in this bulletin are subject to future changes. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.
Reminder: When submitting a claim for HCPCS code G2216, providers must note the dosage dispensed to the patient in the field “units” of the claim form (box 24G of the 1500 Claim Form or Form Locator 46 of the UB-04), rounded to the nearest whole number with a minimum dosage of 1 mg. The claim will then be manually priced based on the dosage dispensed.
Note: The effective date of the policy is January 1, 2025. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the 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.