Opioid Treatment Programs

Opioid treatment program (OTP) services are covered for beneficiaries diagnosed with OUD (per DSM), who voluntarily choose maintenance therapy and are currently opioid-addicted, provided as part of a certified OTP and delivered by authorized providers. Coverage requires a documented initial assessment and specified clinical documentation (medical history, exam, labs, informed consent, treatment plan, withdrawal and safety assessments, drug testing) and periodic assessments per 42 CFR; there is no limit on treatment duration.

"Beneficiary has a diagnosis of opioid use disorder (OUD) established using the Diagnostic and Statistical Manual for Mental Disorders."

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