How To Use HCPCS Code G2069

HCPCS code G2069 describes medication assisted treatment with buprenorphine, specifically the injectable form. This code is used to identify a weekly bundle of services provided by a Medicare-enrolled opioid treatment program. The bundle includes the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed. The code was added to the Healthcare Common Procedure Coding System on January 01, 2020, with an effective date of the same day.

1. What is HCPCS G2069?

HCPCS code G2069 is used to identify medication assisted treatment with buprenorphine in its injectable form. This code represents a comprehensive bundle of services provided by a Medicare-enrolled opioid treatment program. It encompasses the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed. It is important to note that this code specifically applies to the injectable form of buprenorphine and the associated services.

2. Official Description

The official description of HCPCS code G2069 is “Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled opioid treatment program).” The short description for this code is “Med assist tx inject.”

3. Procedure

1. The provider begins by assessing the patient’s eligibility and need for medication assisted treatment with buprenorphine in its injectable form.
2. If the patient meets the criteria, the provider proceeds with the dispensing and/or administration of the medication.
3. Substance use counseling is then provided to the patient, addressing their specific needs and goals in the treatment process.
4. Individual therapy sessions are conducted to further support the patient’s recovery journey and address any underlying issues.
5. Group therapy sessions are also conducted, allowing patients to connect with others who are undergoing similar treatment and providing a supportive environment.
6. If necessary, toxicology testing may be performed to monitor the patient’s progress and ensure compliance with the treatment plan.
7. These steps are repeated on a weekly basis as part of the comprehensive bundle of services provided by the Medicare-enrolled opioid treatment program.

4. When to use HCPCS code G2069

HCPCS code G2069 should be used when a Medicare-enrolled opioid treatment program provides medication assisted treatment with buprenorphine in its injectable form. It is important to ensure that all the components of the weekly bundle, including the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed, are included in the service provided. This code is specific to the injectable form of buprenorphine and the associated services.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2069, healthcare providers should ensure that all the services included in the weekly bundle are documented accurately. This includes documenting the dispensing and/or administration of the medication, substance use counseling sessions, individual and group therapy sessions, and any toxicology testing performed. It is important to maintain detailed records of the services provided and the patient’s response to treatment. Providers should follow the appropriate coding and billing guidelines set forth by Medicare or other insurers.

6. Historical Information and Code Maintenance

HCPCS code G2069 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code represents a significant addition to the coding system, allowing for the identification and billing of medication assisted treatment with buprenorphine in its injectable form.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G2069 may vary depending on the specific policies of Medicare or other insurance providers. The pricing indicator code for this code is 13, which indicates that the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. Providers should consult the relevant guidelines and policies to determine the coverage and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code G2069 should be billed:

1. A patient receives medication assisted treatment with buprenorphine in its injectable form from a Medicare-enrolled opioid treatment program. The weekly bundle of services, including the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed, is provided.
2. A patient undergoes medication assisted treatment with buprenorphine in its injectable form as part of their recovery journey. The weekly bundle of services, including the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed, is provided.
3. A patient with a history of substance use disorder seeks treatment at a Medicare-enrolled opioid treatment program. They receive medication assisted treatment with buprenorphine in its injectable form, along with the associated services included in the weekly bundle.
4. A patient who meets the eligibility criteria for medication assisted treatment with buprenorphine in its injectable form receives the comprehensive bundle of services from a Medicare-enrolled opioid treatment program on a weekly basis.
5. A patient with a documented need for medication assisted treatment with buprenorphine in its injectable form receives the weekly bundle of services, including the dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed, from a Medicare-enrolled opioid treatment program.