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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8 Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.4 Opioid Treatment Program (OTP)

SUD services that are provided in an opioid treatment program (OTP) are a benefit of Texas Medicaid. OTP services are medication-assisted therapy services that threat patients addicted to heroin or other opiates.
OTPs are required to follow guidelines established by the following:
Detoxification in an OTP is the gradual tapering of methadone or buprenorphine doses, which results in the eventual cessation of these drugs. Claims for OTP-based detoxification are submitted as medication-assisted therapy using one of the following procedure codes:
An OTP must have current procedures to ensure that clients are admitted to detoxification treatment by qualified personnel, such as a program physician, who uses established diagnostic criteria to determine that the treatment is appropriate for each client. A client may not be admitted for more than two detoxification episodes in one rolling year. Clients with two or more unsuccessful detoxification episodes with in a 12-month period must be assessed by the OTP physician for other forms of treatment. An assessment for the opioid addiction treatment program must be billed with procedure code H0001 and modifier HG.
There is no billing provider type in Texas Medicaid for an OTP or narcotic treatment clinic. OTPs must either submit claims using the physicians’ provider identifier, or as a Department of State Health Services (DSHS) licensed chemical dependency treatment facility (CDTF).

Texas Medicaid & Healthcare Partnership
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