Rate Provisions

(1) Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of an eligible provider, as explicitly set forth in the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s). (2) Rates as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other sources is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client. (3) Rates of Payment. Payment rates under 101 CMR 444.00 must be the lower of: (a) the eligible provider's usual charge to the general public; or (b) the schedule of allowable rates for services provided by substance use disorder treatment programs as set forth in 101 CMR 444.04(4)(a) and (b). (4) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate except as provided in 101 CMR 444.04(2). (a) Allowable fees for dates of service on or after March 28, 2025 through June 30, 2025: Code Rate Unit Description Per Week Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) Per Week Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) Code Rate Unit Description $1,209.57 Per Week Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) Per Week Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare- enrolled Opioid Treatment Program) Per Initial Visit Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patient’s short-term goals and the tasks the patient must perform to complete the short-term goals; the patient’s requirements for education, vocational rehabilitation, and employment; and the medical, psycho-social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure Per Week Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. Per Week Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. H2015-HF Per 15- Minutes Comprehensive community support services, per 15 minutes (Recovery Support Navigator) H2036-HK Per Diem Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 1) H2036-HF Per Diem Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 2) H0015 Per Diem Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program, 3.5 hours, not to exceed two units a day). Code Rate Unit Description H0015-TF Per Diem Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program, 3.5 hours, not to exceed 2 units a day.) (b) Allowable fees for dates of service on or after July 1, 2025: Code Rate Description See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare- enrolled Opioid Treatment Program) Code Rate Description See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patient’s short-term goals and the tasks the patient must perform to complete the short-term goals; the patient’s requirements for education, vocational rehabilitation, and employment; and the medical, psycho-social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. H2015-HF Comprehensive community support services, per 15 minutes (Recovery Support Navigator) H2036-HK Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 1) H2036-HF Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 2) H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program) H0015-TF Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program)