How To Use HCPCS Code G2074

HCPCS code G2074 describes medication assisted treatment (MAT) services provided by a Medicare-enrolled opioid treatment program. This code encompasses a weekly bundle of services, excluding the cost of the drug itself. The services included in this bundle are substance use counseling, individual and group therapy, and toxicology testing if performed. It is important for medical coders to understand the specific details and usage guidelines for HCPCS code G2074 in order to accurately report and bill for these services.

1. What is HCPCS G2074?

HCPCS code G2074 is used to identify medication assisted treatment services provided by a Medicare-enrolled opioid treatment program. This code represents a weekly bundle of services that do not include the cost of the drug itself. The services included in this bundle are substance use counseling, individual and group therapy, and toxicology testing if performed. It is important to note that this code is specific to Medicare-enrolled opioid treatment programs and may not be applicable for other healthcare providers or insurance plans.

2. Official Description

The official description of HCPCS code G2074 is “Medication assisted treatment, weekly bundle not including the drug, including 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 no drug.”

3. Procedure

1. Patients who are eligible for medication assisted treatment will receive a comprehensive assessment to determine their specific needs and treatment plan.
2. Substance use counseling will be provided to address the patient’s individual needs and support their recovery journey.
3. Individual therapy sessions will be conducted to provide one-on-one support and address any underlying issues contributing to substance use.
4. Group therapy sessions will be conducted to provide a supportive environment where patients can share their experiences and learn from others.
5. Toxicology testing may be performed to monitor the patient’s progress and ensure compliance with the treatment plan.

4. When to use HCPCS code G2074

HCPCS code G2074 should be used when reporting medication assisted treatment services provided by a Medicare-enrolled opioid treatment program. It is important to ensure that the patient meets the eligibility criteria for medication assisted treatment and that the services are provided by a qualified program. This code should not be used for other types of substance abuse treatment or for services provided by non-Medicare-enrolled providers.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2074, healthcare providers should ensure that the following documentation is included:

• Documentation of the patient’s eligibility for medication assisted treatment
• Documentation of the comprehensive assessment and treatment plan
• Documentation of the substance use counseling sessions, including the duration and content of each session
• Documentation of the individual and group therapy sessions, including the duration and topics covered
• Documentation of any toxicology testing performed, including the type of test and results

Providers should also follow the specific billing guidelines and requirements set forth by Medicare and other insurance plans to ensure accurate and timely reimbursement for these services.

6. Historical Information and Code Maintenance

HCPCS code G2074 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of its addition date, 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 plans may provide coverage for medication assisted treatment services billed under HCPCS code G2074. 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, which means it is not applicable as HCPCS priced under one methodology. Providers should verify coverage and reimbursement rates with the respective insurance plans to ensure proper billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G2074 should be billed:

1. A patient with opioid use disorder receives medication assisted treatment services, including substance use counseling, individual and group therapy, and toxicology testing, from a Medicare-enrolled opioid treatment program on a weekly basis.
2. A Medicare beneficiary with opioid use disorder undergoes medication assisted treatment, which includes weekly substance use counseling and group therapy sessions, as well as periodic toxicology testing.
3. An individual with opioid dependence receives medication assisted treatment services, including individual therapy sessions and toxicology testing, from a Medicare-enrolled opioid treatment program on a weekly basis.
4. A patient with opioid addiction receives medication assisted treatment, which includes weekly substance use counseling, individual therapy, and toxicology testing, from a Medicare-enrolled opioid treatment program.
5. A Medicare-enrolled opioid treatment program provides medication assisted treatment services, including substance use counseling, individual and group therapy, and toxicology testing, to eligible patients on a weekly basis.