ED Coding and Reimbursement Alert

If you perform medication assisted treatment, G2213 can help you collect for it.

Emergency departments nationwide have long delivered medication assisted treatment (MAT) for patients who used opioids, but a problem arose when trying to collect for the service, since no codes described it. Fortunately, good news arrived in the form of the 2021 Medicare Physician Fee Schedule (MPFS) final rule, which announced Medicare payment for MAT delivered in the ED.

Background: ED clinicians often use MAT when treating opioid use disorder, allowing the ED to either initiate MAT and/or refer patients for follow-up care. However, the code set didn’t include any specific codes that described this service until now. Effective for dates of service January 1, 2021 and thereafter, CMS will pay for MAT delivered in the ED using add-on code G2213 (Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (List separately in addition to code for primary procedure)).

You’ll bill this code in addition to the ED E/M code (99281-99285) that best describes your service based on the documentation.

Unfortunately, the MPFS didn’t go into a tremendous amount of detail about how to justify reporting this code, saying only, “In response to the request for clarification about which elements are required in order to bill for this code, practitioners should furnish only those activities that are clinically appropriate for the beneficiary that is being treated.”

Check These New Supply Codes

In addition to G2213, CMS also rolled out two codes that describe the cost of giving naloxone (both nasal and injectable) to patients, as follows:

• G2215: Take-home supply of nasal naloxone (provision of the services by a Medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
• G2216: Take-home supply of injectable naloxone (provision of the services by a Medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure

Note: As an opioid treatment program (OTP) provider, you must use only the codes describing bundled payments. Do not use other codes, such as those paid under the Medicare Physician Fee Schedule (MPFS). Only Medicare-enrolled OTPs can bill for G2215 to G2216.

Much like G2213, these represent additional services, so you’ll report them along with the ED E/M code that you’re billing for the day.

Resource: To read the CMS Fact Sheet on MAT, visit www.cms.gov/files/document/otp-billing-and-payment-fact-sheet.pdf.