Common Procedure Coding Systems for Opioid Agonist and Antagonist Treatments; Issued 8/29/2019

[LOGO] CHARLES D. BAKER GOVERNOR KARYN E. POLITO LIEUTENANT GOVERNOR COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation DIVISION OF INSURANCE 1000 Washington Street, Suite 810 • Boston, MA 02118-6200 (617) 521-7794 • Toll-free (877) 563-4467 http://www.mass.gov/doi MIKE KENNEALY SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT EDWARD A. PALLESCHI UNDERSECRETARY OF CONSUMER AFFAIRS AND BUSINESS REGULATION GARY D. ANDERSON COMMISSIONER OF INSURANCE # BULLETIN 2019-07 To: Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations From: Gary D. Anderson, Commissioner of Insurance Date: August 29, 2019 Re: Common Procedure Coding Systems for Opioid Agonist and Antagonist Treatments The Division of Insurance (“Division”) issues this bulletin to Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations offering insured health benefit plans in Massachusetts and behavioral health management firms and third party administrators under contract to these companies (collectively, “Carriers”). This bulletin provides guidance to contracting providers who are initiating or continuing opioid agonist and antagonist treatments regarding common procedure coding to be used when submitting claims for those agonist or antagonist treatments pursuant to the provisions of Section 106 of Chapter 208 of the Acts of 2018. The guidance applies to opioid agonist or antagonist treatment when provided within the following provider settings: (i) acute care hospital emergency departments or satellite emergency facilities; (ii) community-based treatment facilities, outpatient clinics, primary care practices, opioid treatment programs, or office-based treatment clinics; (iii) inpatient facilities providing treatment for substance use disorders; and (iv) any facility used for commitment pursuant to section 35 of chapter 123 of the General Laws for persons with a substance use disorder (collectively, “Providers”). ## Opioid Agonist Treatments Carriers are instructed to establish appropriate systems that will allow for opioid agonist treatments to be available when medically necessary and appropriate to persons covered under insured benefit plans. For the purposes of this bulletin, the Division uses the following definitions: - Opioid agonist treatment: refers to medications approved by the U.S. Food and Drug Administration (“FDA”) to treat opioid use disorder by binding and fully activating the mu-opioid receptor, thereby lessening the symptoms of withdrawal. At adequate doses, Bulletin 2019-07 August 29, 2019 Page 2 of 9 these medications establish opioid blockade and reduce or eliminate cravings for other opioids. Opioid agonist treatment includes the generic medication methadone. - Partial opioid agonist treatment: refers to medications approved by the FDA to treat opioid use disorder by binding yet only partially activating the mu-opioid receptor, thereby lessening the symptoms of withdrawal. At adequate doses, these medications establish opioid blockade, and reduce or eliminate cravings for other opioids. Partial opioid agonist treatment includes the generic medications buprenorphine and buprenorphine/naloxone. - Medication-assisted treatment: refers to the Substance Abuse and Mental Health Services Administration (SAHMSA) definition, which is “the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” Although this bulletin is specifically focused on the pharmacological components of medication-assisted treatment (“Medications for Addiction Treatment” or “MAT”), the Division recognizes that a patient may require diagnostic, medical, and behavioral services in addition to MAT in order to address the patient’s full complement of needs. Carriers’ systems are expected to provide medically necessary access to at least one (1) opioid agonist treatment and at least one (1) partial agonist treatment without preauthorization up to the FDA-approved dose recommendations, but not exceeding FDA daily dose limitations, for treatment of opioid use disorder. Any amount beyond FDA-approved recommendations may be subject to a carrier’s preauthorization requirements. Carriers may administer opioid agonist and partial agonist treatments as either prescription drug or medical benefits, but treatments that are treated as medical benefits must be at least as generous as such benefits would be if treated as a prescription benefit. Carriers may limit coverage of opioid agonist and partial agonist treatments to those prescription drugs on their formularies or to generic types of drugs, provided that Carriers institute appropriate exception procedures where brand-name or off-formulary prescription drugs are medically indicated for the patient. Carriers with managed care networks are expected to establish networks with adequate access to opioid agonist treatment and partial agonist treatment for all covered persons within the Carrier’s service delivery system. The Division would find it appropriate if Carriers’ systems enable access to at least buprenorphine monotherapy or buprenorphine/naloxone combination therapy, for doses of up to 16 milligrams per day, to be covered without preauthorization so that clinicians can make decisions based on the patient profile and whether the medication is being given under supervision or is being given as a take-home dosing kit. For doses greater than 16mg/day, carriers may institute authorizations for continued use to ensure patients are maintained on the lowest possible dose. Additionally, carriers must not impose any policies pertaining to take-home medications, including methadone, that are more restrictive than those set forth in 105 CMR 164.00. Medications for Addiction Treatment can be provided in a variety of healthcare settings by a range of practitioners, including but not limited to (i) acute care hospital emergency departments or satellite emergency facilities; (ii) community-based treatment facilities, outpatient clinics, primary care practices, opioid treatment programs, or office-based treatment clinics; (iii) inpatient facilities providing treatment for substance use disorders; and (iv) any facility used for commitment pursuant to section 35 of chapter 123 of the General Laws for persons with a substance use disorder. Bulletin 2019-07 August 29, 2019 Page 3 of 9 ## Opioid Antagonist Treatments In addition, opioid antagonist treatments are available. Naltrexone is available without prior authorization and without a specialty pharmacy requirement for at least the first fill. For naloxone, plans are required to cover at least one formulation of naloxone without prior authorization in accordance with guidance as issued by the Division. Furthermore, the Department of Public Health issued a statewide standing order pursuant to Section 32 of Chapter 208 of the Acts of 2018 for the broad distribution of naloxone to any resident of the Commonwealth. ## Common Coding Systems for Opioid Agonist and Antagonist Treatments The Division acknowledges the benefits of developing a set of common codes that apply to opioid agonist and antagonist treatments to facilitate Providers' billing of covered services. The Division recognizes that methods and rates of reimbursement are negotiated between Carriers and Providers; thus, no one method perfectly serves in all situations, especially where Carriers and Providers may bundle services into one common payment code. The Division therefore establishes a set of claim codes that are representative of services specific to opioid agonist and antagonist treatments that could be used by Carriers and Providers when negotiating the appropriate way to develop methods and rates of reimbursement for covered members. The codes, which are identified in Appendices 1 and 2, represent a baseline set of codes that may be used as Carriers and Providers negotiate contracts. As to the codes and payment policies utilized by an individual Carrier's health plan, network providers will need to refer to provisions included within their contracts with their payer. ## Coding for Other Services Provided During Opioid Agonist or Antagonist Treatments While an individual is undergoing opioid agonist or antagonist treatments or partial opioid agonist treatment, a Provider may identify other services that the Provider believes the individual may need to test or be treated for, including, for example, testing for hepatitis or other conditions. These services are subject to medical necessity review and may be subject to the Carrier's prior authorization, utilization review, and/or payment policy protocols. Under M.G.L. c. 176O, insured health plans may develop medical necessity criteria to determine whether certain services are medically necessary and appropriate to treat a person's condition. As noted in M.G.L. c. 176O, §16(b): A carrier may develop guidelines to be used in applying the standard of medical necessity, as defined in this subsection. Any such medical necessity guidelines utilized by a carrier in making coverage determinations shall be: (i) developed with input from practicing physicians and participating providers in the carrier's or utilization review organization's service area; (ii) developed under the standards adopted by national accreditation organizations; (iii) updated at least biennially or more often as new treatments, applications and technologies are adopted as generally accepted professional medical practice; and (iv) evidence-based, if practicable. In applying such guidelines, a carrier shall consider the individual health care needs of the insured. Any such medical necessity guidelines criteria shall be applied consistently by a carrier or a utilization review organization and made easily accessible and up-to-date on a carrier or utilization review organization's website to subscribers, health care providers and the general public. If a carrier or utilization review organization Bulletin 2019-07 August 29, 2019 Page 4 of 9 intends either to implement a new medical necessity guideline or amend an existing requirement or restriction, the carrier or utilization review organization shall ensure that the new or amended requirement or restriction shall not be implemented unless the carrier's or utilization review organization's website has been updated to reflect the new or amended requirement or restriction. When processing a claim for any of such services, a Provider should follow the appropriate procedural coding systems identified by the member's Carrier. If you have any questions about this bulletin, please contact Kevin Beagan, Division of Insurance, at (617) 521-7323 or kevin.beagan@mass.gov. Bulletin 2019-07 August 29, 2019 Page 5 of 9 ## Appendix 1 Coding used for addiction treatment when administered by a clinician, orally or through injection, based on National Drug Coding (NDC) and Procedure Codes Identified as Medications for Addiction Treatment HCPCS codes for MAT: | H0020 | Methadone dose and administration | | --- | --- | | J0571 | Buprenorphine, oral, 1 mg | | J0572 | Buprenorphine/ Naloxone, oral, less than or equal to 3 mg buprenorphine | | J0573 | Buprenorphine/ Naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine | | J0574 | Buprenorphine/ Naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | | J0575 | Buprenorphine/ Naloxone, oral, greater than 10 mg buprenorphine | | S0109 | Methadone, oral, 5 mg | | J1230 | Injection, Methadone HCL, up to 10mg | | J2315 | Injection, Naltrexone, up to 1mg | NDCs for Buprenorphine: | 00054017613 | Buprenorphine Hydrochloride | | --- | --- | | 00054017713 | Buprenorphine Hydrochloride | | 00054018813 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00054018913 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00093537856 | Buprenorphine Hydrochloride | | 00093537956 | Buprenorphine Hydrochloride | | 00093572056 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00093572156 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00228315303 | Buprenorphine Hydrochloride | | 00228315403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00228315473 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00228315503 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00228315573 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00228315603 | Buprenorphine Hydrochloride | | 00378092393 | Buprenorphine Hydrochloride | | 00378092493 | Buprenorphine Hydrochloride | | 00406192303 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00406192403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00490005100 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00490005130 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00490005160 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 00490005190 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120201 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120203 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120401 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120801 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496120803 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496121201 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496121203 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496127802 | Buprenorphine Hydrochloride | | 12496128302 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496130602 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 12496131002 | Buprenorphine Hydrochloride | | 16590066605 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 16590066630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 16590066705 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | Bulletin 2019-07 August 29, 2019 Page 6 of 9 | 16590066730 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | --- | --- | | 16590066790 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 23490927003 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 23490927006 | Buprenorphine Hydrochloride/ Naloxone Hydrochloride Dihydrate | | 23490927009 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 35356000407 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 35356000430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 35356055530 | Buprenorphine Hydrochloride | | 35356055630 | Buprenorphine Hydrochloride | | 42291017430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 42291017530 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 43063018407 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 43063018430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 49999039507 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 49999039515 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 49999039530 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 52959030430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 52959074930 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 53217013830 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123011430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123091430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123092930 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123095730 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123098630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573900 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573901 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573902 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569639900 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569640800 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569657800 | Buprenorphine Hydrochloride | | 54868570700 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570701 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570702 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570703 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570704 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868575000 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55045378403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700014730 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700018430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700030230 | Buprenorphine Hydrochloride | | 55700030330 | Buprenorphine Hydrochloride | | 59385001201 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001230 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001401 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001601 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629402801 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403401 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403402 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629409201 | Buprenorphine Hydrochloride | | 63874108403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63874108503 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63874117303 | Buprenorphine Hydrochloride | Bulletin 2019-07 August 29, 2019 Page 7 of 9 | 65162041503 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | --- | --- | | 65162041603 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 66336001630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68071138003 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68071151003 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68258299103 | Buprenorphine Hydrochloride | | 68258299903 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68308020230 | Buprenorphine Hydrochloride | | 68308020830 | Buprenorphine Hydrochloride | | 52959030430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 52959074930 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 53217013830 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123011430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123091430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123092930 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123095730 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54123098630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573900 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573901 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569573902 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569639900 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569640800 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54569657800 | Buprenorphine Hydrochloride | | 54868570700 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570701 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570702 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570703 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868570704 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 54868575000 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55045378403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700014730 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700018430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 55700030230 | Buprenorphine Hydrochloride | | 55700030330 | Buprenorphine Hydrochloride | | 59385001201 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001230 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001401 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001430 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001601 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 59385001630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629402801 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403401 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403402 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629403403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63629409201 | Buprenorphine Hydrochloride | | 63874108403 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63874108503 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 63874117303 | Buprenorphine Hydrochloride | | 65162041503 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 65162041603 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 66336001630 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68071138003 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68071151003 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | | 68258299103 | Buprenorphine Hydrochloride | | 68258299903 | Buprenorphine Hydrochloride / Naloxone Hydrochloride Dihydrate | Bulletin 2019-07 August 29, 2019 Page 8 of 9 68308020230 Buprenorphine Hydrochloride 68308020830 Buprenorphine Hydrochloride # NDCs for Naltrexone | 00056001122 | Naltrexone HCL | | --- | --- | | 00056001130 | Naltrexone HCL | | 00056001170 | Naltrexone HCL | | 00056007950 | Naltrexone HCL | | 00056008050 | Naltrexone HCL | | 00185003901 | Naltrexone HCL | | 00185003930 | Naltrexone HCL | | 00406009201 | Naltrexone HCL | | 00406009203 | Naltrexone HCL | | 00406117001 | Naltrexone HCL | | 00406117003 | Naltrexone HCL | | 00555090201 | Naltrexone HCL | | 00555090202 | Naltrexone HCL | | 16729008101 | Naltrexone HCL | | 16729008110 | Naltrexone HCL | | 42291063230 | Naltrexone HCL | | 43063059115 | Naltrexone HCL | | 47335032683 | Naltrexone HCL | | 47335032688 | Naltrexone HCL | | 50436010501 | Naltrexone HCL | | 51224020630 | Naltrexone HCL | | 51224020650 | Naltrexone HCL | | 51285027501 | Naltrexone HCL | | 51285027502 | Naltrexone HCL | | 52152010502 | Naltrexone HCL | | 52152010504 | Naltrexone HCL | | 52152010530 | Naltrexone HCL | | 54868557400 | Naltrexone HCL | | 63459030042 | Naltrexone Microspheres | | 65694010003 | Naltrexone HCL | | 65694010010 | Naltrexone HCL | | 65757030001 | Naltrexone Microspheres | | 65757030202 | Naltrexone Microspheres | | 68084029111 | Naltrexone HCL | | 68084029121 | Naltrexone HCL | | 68094085362 | Naltrexone HCL | | 68115068030 | Naltrexone HCL | Source: Center for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse (CCW) – Opioid-related indicators and Algorithms. 2018. https://www.ccwdata.org/web/guest/condition-categories Bulletin 2019-07 August 29, 2019 Page 9 of 9 ## Appendix 2 Coding used by for assessment, evaluation, prescribing, and administration of medications for addiction treatment | CPT 99201-99205 | Outpatient visit for the evaluation and management of a new patient | | --- | --- | | CPT 99211-99215 | Office or other outpatient visit for the evaluation and management of an established patient | | CPT 99281-99285 | Initial/normal ED charges | | CPT 96372 | Therapeutic prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | | CPT 99217-99220 | Initial Observation (New or Established Patient) | | HCPCS H0001 | Alcohol and/or drug assessment (substance use disorder programs only) | | HCPCS H0020 | Alcohol and/or drug services methadone administration and/or service (provision of the drug by a licensed program) (dose only visit) (substance use disorder programs only) | | HCPCS H0033 | Oral medication administration, direct observation (substance use disorder programs only) | | HCPCS T1015 | Clinic visit/encounter, all-inclusive (community health centers only) | | CPT 99199 | Other Medicine Services and Procedures (Tracking and monitoring of Naloxone dispensing at discharge) | Carriers should refer Providers to their plan contracts for carrier-specific coding information.