Emergency physicians who initiate and coordinate opioid treatment in the emergency department for Indiana Medicaid patients can begin billing for the service in July.
According to the Indiana Health Coverage Programs (IHCP), for dates of service on or after July 7, 2022, the IHCP will cover procedure code G2213 – Initiation of medication for the treatment of opioid use disorder in the emergency department setting.
The procedure code for the medication assisted treatment (MAT) covers any or all of the following components, and not all need to be provided to bill for the service. In fact, providers are limited to providing only the services that are clinically appropriate:
- Assessment
- Referral to ongoing care
- Follow-up after treatment begins
- Arranging access to supportive services
Reimbursement for the professional service is based on the resource-based relative value scale (RBRVS), and providers should report G2213 in addition to an ED visit evaluation and management (E/M) code.
To prescribe buprenorphine, providers need an X-waiver from the Substance Abuse and Mental Health Administration (SAMHSA). Typically, an X-waiver requires extensive training and a lengthy application process. While a 2021 exemption now allows providers who treat 30 or fewer opioid use disorder patients to simply submit a Notice of Intent to SAMHSA to receive an X-waiver, Indiana Code IC 12-23-21-3 still mandates training.
Despite the requirements for prescribing buprenorphine, the Drug Enforcement Administration (DEA) allows DEA-registered emergency physicians to dispense (but not prescribe) a three-day supply of MAT, like buprenorphine and methadone, to treat patients with withdrawal symptoms while arrangements are being made for a referral.
Initially, the “Three Day Rule” required physicians to dispense the three days of medication one day at a time, requiring patients to come to the ED three times within a 72-hour window. However, additional flexibility was given on March 23, 2022, allowing DEA-registered physicians working in a hospital, clinic or ED to request an exception to the one-day supply limitation. Now, the DEA will grant requests to allow physicians to dispense (but not prescribe) up to a three-day supply of the medication in a single visit.
For more information, check out the following resources:
- To submit “Three Day Rule” exception requests, visit the DEA Diversion Control Division page.
- To become a SAMHSA Buprenorphine Waivered Practitioner, visit the SAMHSA website.
- To learn more about the IHCP’s coverage for G2213 for opioid treatment, review the IHCP bulletin BT202243 from June 7, 2022.
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