ATTENTION OASAS FREESTANDING OPIOID TREATMENT PROGRAMS

Oasas

ATTENTION OASAS FREESTANDING OPIOID TREATMENT PROGRAMS

Effective January 6, 2014 APG reimbursement methodology will be fully implemented in Freestanding Opioid Treatment programs.

This is a reminder that effective January 6, 2014 APG reimbursement will be fully implemented in Freestanding Opioid Treatment Programs. This is the conclusion of the multi-year phase-in from the blended threshold/legacy APG reimbursement methodology to full APG reimbursement. Effective January 6, 2014 reimbursement for services provided will be calculated using only the APG reimbursement methodology (e.g. APG base rate X service weight, minus any applicable service discounts). Therefore, effective January 6, 2014 the legacy reimbursement portion is phased out; meaning the rate code 1671 should no longer be used.

Effective for dates of service January 6, 2014 forward, OTP programs will only submit one claim. Using the rate code 1564, providers will code on the line level the services that were provided for the billing week. OTP providers will continue to bill the first Medication Administration (H0020) of the week with the “KP” Modifier. Reimbursement for the 1564 rate code claim will continue to be paid using APG reimbursement methodology (including applying APG discounts when appropriate).

For claims with dates of service prior to January 6, 2014, OTP programs submit two claims. Claim One—using the rate code 1671 in the header of the claim, enter the HCPCS code H0020 on the line level. This claim obtains the legacy portion of the reimbursement. Claim Two—using the rate code 1564 in the header of the claim, enter on the line level the HCPCS/CPT codes for the APG services provided to the client during the billing the week. This claim obtains the APG portion of the reimbursement.

The rate code 1471 remains unaffected by the conversion to full APG reimbursement methodology. Rate code 1471 will continue to reimburse as it has throughout the phase in of APGs.

Note: Hospital-based OTP providers continue to be reimbursed the threshold/legacy amount.

If you have questions regarding this notification, please e-mail the APG mailbox at APG@oasas.ny.gov.

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