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IGG Posted Mon 27th of June, 2016 13:06:04 PM
Could you please advise as to the appropriate code to use to bill Medicare Part B for medication management with methadone for patients enrolled in an outpatient methadone maintenance clinic (clinic dedicated to the service provision of opioid substitution therapy/opioid pharmacotherapy)
SuperCoder Answered Tue 28th of June, 2016 01:57:19 AM
Hi, As per Medicare policy, "Methadone may be covered if provided to hospital inpatients but not provided in outpatient clinics" Also, Methadone is not a Part D drug when used for treatment of opioid dependence because it cannot be dispensed for this purpose upon a prescription at a retail pharmacy. Please refer to following link for further clarifications. http://www.medicareinteractive.org/get-answers/medicare-covered-services/mental-health-services/medicare-coverage-of-treatment-for-alcoholism-and-drug-abuse
https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/determine.pdf
Hope this helps. Thanks.

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