As of January 1, 2020, Opioid Use Disorder (OUD) treatment service provided by Opioid Treatment Programs (OTPs) are now covered as a Medicare Part B benefit.

Under the Calendar Year 2020 Physician Fee Schedule final rule, Opioid Treatment Programs will be covered by Molina’s Medicare Advantage (D-SNP). For Molina D-SNP beneficiaries who currently receive OTP services through Medicaid, these services will be covered as a Medicare benefit effective January 1, 2020.

In order to bill and receive payment from Molina for D-SNP members for opioid use disorder treatment services at an OTP facility, the OTP provider must be

1. Certified and accredited by SAMHSA
2. Enrolled in the Medicare program as a Medicare OTP provider

Prior authorization is NOT required, except for those providers not contracted with Molina. If not currently contracted, please fax your request to Molina at 800-594-7404.

Click here to read the full announcement from Molina.