Reimbursement for MAT

February 21, 2021

By Stacie Norris, Director, Coding Quality Assurance | February 19, 2021

Medication Assisted Treatment (MAT) is used to treat substance use disorder, as well as sustain recovery and prevent overdose. Previously, we explained that the 2021 Medicare Physician Fee Schedule final rule (MPFS) included a new reimbursement code, G2213, for emergency physicians. Physicians with 1.89 total RVUs and 1.3 W-RVUs, are paid approximately $66 per code in 2021 (assuming no geographic adjustment).  The G2213 is an add on code (use as appropriate, in addition to the ED Evaluation and Management code). 

Key Takeaways:

• CMS has finalizing its proposal to reimburse for MAT delivered in the ED starting in 2021.
• The delay in guidance was due in part to changes regarding the “X-waiver” (required by the DATA Act of 2020, physicians take an 8 hour training course and apply for a waiver to eventually be issued by the DEA).
• Per FAQs (4 & 5), the change in administrations caused the requirements for ED physicians to have received the “X-waiver” to prescribe key MAT therapies to come back on after being eliminated in the prior administration on Jan. 14, 2021.
• The best documentation practice would be a note describing the indications for MAT, the specific medications employed, and the follow up process as well as including a diagnosis of opioid use disorder (OUD) with an ICD-10 from the F11 family of codes.
• MAT add on code G2213 is now available for reporting.

ACEP has finalized and posted its MAT-FAQs. Stay tuned for Zotec’s continued guidance on the regulatory requirements and documentation that should be required to bill for the add on code.

Learn more about Zotec Partners here.