101 CMR, § 444.04

Current through Register 1538, January 3, 2025

Section 444.04 - Rate Provisions

(1)Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of an eligible provider, as explicitly set forth in the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s).

(2)Rates as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other sources is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3)Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate except as provided in 101 CMR 444.04(2).

(4)Approved Program Rates. The rate of payment for authorized services is the lower of the established charge or rate listed below. Refer to purchasers' manuals for special coding instructions and limitations on number of units.

Code	Rate	Unit	Description
G2067	$190.82	Per Week	Medication assisted treatment, methadone; 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)
G2068	$227.96	Per Week	Medication assisted treatment, buprenorphine (oral); 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)
G2073	$1,209.57	Per Week	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)
G2074	$149.34	Per Week	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)
G2076	$165.73	Per Initial Visit	Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho-social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure
G2078	$31.77	Per Week	Take-home supply of methadone; up to seven additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure.
G2079	$68.92	Per Week	Take-home supply of buprenorphine (oral); up to seven additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure.
H2015-HF	$17.09	Per 15 Minutes	Comprehensive community support services, per 15 minutes (Recovery Support Navigator)
H2036 - HK	$766.01	Per Diem	Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 1)
H2036 - HF	$556.02	Per Diem	Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 2)

101 CMR, § 444.04

Amended by Mass Register Issue 1485, eff. 1/1/2023.