How To Maximize Reimbursement For Mat Services

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How to Maximize Reimbursement For MAT Service
Medication-Assisted Treatment (MAT) is an evidence-based approach for treating opioid use disorder (OUD), combining FDA-approved medications with counseling and behavioral therapy. While MAT significantly improves patient outcomes, providers often face billing and reimbursement challenges due to strict compliance rules, payer-specific guidelines, and frequent regulatory changes.

To sustain and expand these life-saving programs, healthcare organizations must master the art of MAT billing—ensuring every claim is accurate, compliant, and optimized for maximum reimbursement. This guide explores the essential steps, from accurate HCPCS codes to streamlined electronic health record and billing integration, and the benefits of outsourcing medical billing and coding services to industry experts.

1. Understanding the Core Elements of MAT Billing
To secure higher reimbursement, providers must understand the building blocks of MAT billing and apply them consistently.

a. Accurate Medication Coding Using HCPCS Codes

Each medication used in MAT has specific ...
... HCPCS and CPT codes:

G2067 – Methadone treatment in an outpatient setting

G2068 – Buprenorphine treatment in an outpatient setting

J0572 – Buprenorphine/naloxone (oral) ≤3 mg

Using correct codes based on the medication and dosage is critical. Incorrect coding leads to denials or reduced payments, making it vital to update code lists according to CMS and payer updates.

b. Correctly Identifying the Treatment Setting

Reimbursement depends heavily on where MAT services are delivered:

Outpatient Clinics – Codes such as G2067 or G2068

Emergency Departments (ED) – G2213 for initiating MAT in ED

Opioid Treatment Programs (OTP) – Bundled codes with unique rules

Proper documentation and place-of-service (POS) codes ensure correct claim processing.

c. Comprehensive Documentation of All Services

MAT involves more than medication—it includes counseling and behavioral therapies. Key codes include:

90832–90837 – Counseling sessions (various durations)

99408 – Brief intervention & substance abuse screening

Detailed records of session time, patient progress, and clinical notes support medical necessity and avoid denials.

2. Strategies to Maximize MAT Reimbursement
a. Real-Time Claim Validation

Implement billing software that validates claims before submission. This ensures:

All required fields are complete

Correct HCPCS/CPT codes are used

Documentation supports billed services

Error-free submissions speed reimbursement and improve cash flow.

b. Customizing Billing to Payer Requirements

Different insurers have unique MAT billing rules—some bundle medication and therapy, while others require separate claims. Adapting your process to each payer minimizes rejections and improves first-pass acceptance rates.

c. Integrating Clinical & Billing Systems

Using an electronic health record and billing platform designed for MAT ensures clinical notes, medication details, and counseling sessions automatically generate correct billing codes. This reduces manual errors and ensures all billable services are captured.

d. Negotiating with Payers

Present MAT outcome data—reduced opioid use, fewer hospitalizations—to negotiate better reimbursement rates or participate in value-based care models. This can result in higher payments and bundled coverage for both medication and behavioral therapy.

e. Correct Use of Modifiers

When billing for multiple MAT services on the same day, use modifiers such as -59 (distinct procedural service) or U5 (MAT-specific indicator). This helps payers recognize each service separately and avoids partial payments.

f. Accurate Place of Service Codes

Examples include:

POS 11 – Outpatient clinic

POS 23 – Emergency department MAT initiation

POS 71 – Opioid treatment program

Using correct POS codes prevents claim rejections and ensures accurate reimbursement.

g. Leveraging Telehealth Billing Codes

For virtual MAT services, use appropriate codes such as G2012 (virtual check-in) or 99421–99423 (remote evaluation). Correct telehealth billing supports reimbursement for remote care.

h. Clear Documentation of Medication Dosages

List all dosages, administration dates, and changes clearly to justify ongoing billing for medication management and to avoid payer disputes.

3. Why Outsourcing MAT Billing Makes Sense
Outsourcing medical billing and coding services—especially to specialists in MAT—reduces administrative burden and increases revenue. Expert billing companies understand MAT-specific coding, stay updated on regulatory changes, and manage denials efficiently. This allows providers to focus on patient care rather than navigating complex reimbursement rules.

FAQs

Q1: Who can bill for MAT services?

Only providers meeting federal and state certification requirements are eligible to bill for MAT services.

Q2: Can group therapy in MAT be billed?

Yes, if payer rules allow and the correct CPT codes are used.

Q3: Are lab tests during MAT reimbursable?

Yes, if billed correctly, drug screenings and related lab work can be reimbursed separately.

Q4: How often can MAT follow-ups be billed?

Frequency depends on payer guidelines—some allow weekly or biweekly billing.

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