How To Use HCPCS Code G2073

HCPCS code G2073 describes medication assisted treatment with naltrexone, which includes a weekly bundle of services such as dispensing and/or administration of the medication, substance use counseling, individual and group therapy, and toxicology testing if performed. This code is specifically used for services provided by a Medicare-enrolled opioid treatment program.

1. What is HCPCS G2073?

HCPCS code G2073 is a specific code used to identify medication assisted treatment with naltrexone. It is used to bill for a comprehensive bundle of services provided by a Medicare-enrolled opioid treatment program. This code encompasses various components of treatment, including the dispensing and/or administration of naltrexone, substance use counseling, individual and group therapy, and toxicology testing if performed.

2. Official Description

The official description of HCPCS code G2073 is “Medication assisted treatment, naltrexone; 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 tx naltrexone.”

3. Procedure

1. The provider begins by assessing the patient’s eligibility and need for medication assisted treatment with naltrexone.
2. If the patient meets the criteria, the provider dispenses or administers the naltrexone medication.
3. The patient receives substance use counseling to address their specific needs and support their recovery.
4. Individual therapy sessions are conducted to provide personalized treatment and address any underlying issues contributing to substance use.
5. Group therapy sessions are conducted to provide peer support and facilitate discussions on recovery and relapse prevention.
6. If necessary, toxicology testing may be performed to monitor the patient’s progress and ensure compliance with the treatment plan.

4. When to use HCPCS code G2073

HCPCS code G2073 should be used when billing for medication assisted treatment with naltrexone provided by a Medicare-enrolled opioid treatment program. It is important to ensure that the services included in the weekly bundle, such as dispensing and/or administration of naltrexone, substance use counseling, individual and group therapy, and toxicology testing if performed, are all provided as part of the treatment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2073, healthcare providers should ensure that the documentation supports the services provided. This may include documenting the dispensing or administration of naltrexone, substance use counseling sessions, individual and group therapy sessions, and any toxicology testing performed. It is important to accurately reflect the duration and frequency of each service to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G2073 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.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover medication assisted treatment with naltrexone billed under HCPCS code G2073. The pricing indicator code 13 indicates that the price for this code is established by carriers, meaning it is determined on an individual basis. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G2073 should be billed:

1. A patient visits an opioid treatment program and receives a weekly bundle of services, including the dispensing of naltrexone, substance use counseling, individual therapy, group therapy, and toxicology testing.
2. A Medicare-enrolled opioid treatment program provides medication assisted treatment with naltrexone to a patient who meets the eligibility criteria.
3. A patient undergoes a comprehensive treatment program that includes the administration of naltrexone, substance use counseling, individual therapy, group therapy, and toxicology testing.
4. An opioid treatment program dispenses naltrexone and provides counseling and therapy services to a patient as part of their medication assisted treatment.
5. A patient receives medication assisted treatment with naltrexone, which includes the dispensing of the medication, counseling sessions, therapy sessions, and toxicology testing if necessary.