Revision to Provider Communication Bulletin #96: Changes to Outpatient Opioid Treatment (OOT) Benefit Limit for State and Medicaid
Service Codes:
H0020 (Per diem) – Opioid Treatment Services
H0020U3BU (Weekly) – Opioid Treatment Services
On August 15, 2019, Partners announced that providers of Outpatient Opioid Treatment (OOT) may request up to 90 units for 90 days for initial H0020 authorizations and up to 13 units for 90 days for initial H0020U3BU authorizations.
It has come to our attention that Clinical Policy for NC Medicaid only allows 60 days for initial treatment. Therefore, Partners is revising the benefit limit for Outpatient Opioid Treatment, effective September 18, 2019. Providers may only request up to 60 units for 60 days for initial H0020 authorizations and up to 9 units for 60 days for initial H0020U3BU authorizations. These changes are applicable for both State and Medicaid funded members.
Providers may continue to request up to up to 180 units for 180 days for concurrent H0020 authorizations and up to 26 units for 180 days of H0020U3BU authorizations. The benefit limit for concurrent authorizations will not change.
If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.