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Table 1 Reported or estimated weekly Medicaid OTP methadone bundle fee by state, as of March 2021

From: Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

State

Regular Methadone Bundle Fee Components (weekly)

Additional Payments (weekly)

Methadone treatment bundle fee

Dispensing and/or Administration

Individual Therapy (30 minutes)

Group Therapy (30 minutes)

Toxicology Testing

Total Regular Methadone Bundle Fee (weekly)

Care Coordination or Case Management (1 hour except as noted)

Opioid Health Home or Center of Excellence (weekly)

Total Regular Methadone Bundle Fee and Additional Payments (weekly)

Alabama

$119.00

X

X

X

X

$119.00

n.d.

n.d.

$119.00

Alaska

$143.85

X

$63.98

$25.59

$12.60

$246.02

$98.80

n.d.

$344.82

Arizonaa

$26.32

X

$40.50

$13.94

$12.60

$93.36

$27.22

n.d.

$202.24

Arkansas

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

California

$99.40

X

X

X

X

$99.40

n.d.

n.d.

$99.40

Coloradoa

$103.81

X

$45.54

$15.08

$12.89

$177.32

$34.20

n.d.

$211.52

Connecticut

$92.69

X

X

X

X

$92.69

n.d.

n.d.

$92.69

Delawarea,b

$28.00

X

$38.66

$6.44

$8.20

$81.30

n.d.

n.d.

$81.30

District of Columbiaa

$60.06

X

$57.62

$7.21

$8.80

$133.69

$105.68

n.d.

$239.37

Florida

$67.48

X

X

X

X

$67.48

n.d.

n.d.

$67.48

Georgia

$121.80

X

X

X

X

$121.80

n.d.

n.d.

$121.80

Hawaii

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Idaho

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Illinoisa

$70.00

X

$31.06

$11.74

$4.49

$117.29

$50.80

n.d.

$168.09

Indiana

$112.35

X

X

X

X

$112.35

n.d.

n.d.

$112.35

Iowac

$199.09

X

X

X

X

$199.09

n.d.

n.d.

$199.09

Kansas

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Kentucky

$105.00

X

X

X

X

$105.00

n.d.

n.d.

$105.00

Louisiana

$114.31

X

X

X

X

$114.31

n.d.

n.d.

$114.31

Maine

$81.60

X

X

X

X

$81.60

n.d.

$42.40

$124.00

Maryland a

$74.10

X

$46.36

$22.61

X

$143.07

n.d.

$26.45

$169.52

Massachusettsa

$78.82

X

$40.22

$11.76

X

$130.80

$78.52

n.d.

$209.32

Michigand

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

$104.45

$104.45

Minnesota

$93.73

X

X

X

X

$93.73

n.d.

n.d.

$93.73

Mississippi

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Missouri

$52.78

X

X

X

X

$52.78

n.d.

n.d.

$52.78

Montana

$125.00

X

X

X

X

$125.00

n.d.

n.d.

$125.00

Nebraskac

$199.08

X

X

X

X

$199.08

n.d.

n.d.

$199.08

Nevada

$25.97

X

$54.32

$28.06

$13.36

$121.71

$32.40

n.d.

$154.11

New Hampshire

$76.09

X

$69.11

$28.26

$9.32

$182.78

n.d.

n.d.

$182.78

New Jersey

$91.15

X

X

X

X

$91.15

n.d.

n.d.

$91.15

New Mexico

$120.54

X

X

X

X

$120.54

n.d.

n.d.

$120.54

New Yorkc

$207.49

X

X

X

X

$207.49

n.d.

n.d.

$207.49

North Carolinaa

$116.20

X

$39.62

$5.12

$14.29

$175.23

$81.25 (weekly)

n.d.

$256.48

North Dakotac

$207.49

X

X

X

X

$207.49

n.d.

n.d.

$207.49

Ohio

$114.66

X

$48.99

$19.27

$6.67

$189.59

$78.16

n.d.

$267.75

Oklahoma

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Oregona

$34.93

X

$53.02

$46.80

$12.63

$147.38

$90.00

n.d.

$237.62

Pennsylvaniaa

$52.50

X

$50.00

$3.50

$11.97

$117.97

$30.00

$69.31

$217.28

Rhode Island

$87.52

X

X

X

X

$87.52

n.d.

$53.50

$141.02

South Carolinac

$102.04

X

X

X

X

$102.04

n.d.

n.d.

$102.04

South Dakota

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Texasa

$77.00

X

$29.00

$28.00

$13.10

$147.10

n.d.

n.d.

$147.10

Utah

$40.95

X

$59.82

$6.96

$5.02

$112.75

$67.32

n.d.

$180.07

Vermonte

$105.00

X

X

X

X

$105.00

n.d.

$34.81

$139.81

Virginiaa,f

$56.00

X

$48.00

$14.50

$14.96

$133.46

$60.75

n.d.

$194.21

Washington

$110.67

X

X

X

X

$110.67

n.d.

n.d.

$110.67

West Virginia

$105.00

X

X

X

X

$105.00

n.d.

n.d.

$105.00

Wisconsina,g

$73.14

X

$54.04

$3.16

$57.66

$188.00

$43.28

n.d.

$231.28

Wyoming

n.d.

n.d.

n.d.

n.d.

n.d.

-—

n.d.

n.d.

-—

Medicare

$212.00

X

X

X

X

$212.00

  

$212.00

  1. Source: Authors' analysis of Medicaid physician fees posted to state websites as of March 2021; Tennessee is excluded because it does not establish fee-for-service Medicaid provider fees
  2. Notes: "X" indicates service covered in Medicaid OTP Methadone bundle fee; n.d. = no data, either data not available or service not covered; -— = could not be computed due to lack of data; Medicare 2021 national rate; OHH = Opioid Health Home. No data was available for any relevant payment for Arkansas, Hawaii, Idaho, Kansas, Michigan (except OHH payments), Oklahoma, South Dakota, and Wyoming. Duration varies for H0004 and H0005, so each is converted to a per 30-minute fee for purposes of the estimated weekly bundle fee. Care coordination/case management duration also varies, so each is converted to a per 1 hour fee
  3. The regular methadone bundle fee (weekly) is based on the Medicare HCPCS G2067, "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)." We used combinations of the HCPCS and CPT codes H0020, H0016, G2067, H0004, 90832, H0005, 90853, H0003, H0048, 80305, H0006, G9012, T1016, T1017, H0032, 81020, and S9445, as appropriate with state-specific codes and usage, to create bundles based on the Medicare HCPCS G2067
  4. aFee rates were adjusted to be consistent with the bundle as described, e.g. Individual Therapy (15 minutes) was multiplied by two to obtain Individual Therapy (30 minutes)
  5. bDelaware is not included in the index computation as private communication from the state indicated that the Medicaid FFS rates are very infrequently used and may be substantially lower than the MMC rates for OTP services, thus are not representative of state payments generally
  6. cUses Medicare G Codes
  7. dThis rate is the weekly estimate of Michigan's S0280 HG Recovery Action Plan Rate for the first month of OHH care at an OTP; subsequent months have lower payment
  8. eVermont's health home fee is an unweighted average of their fee for hubs and spokes
  9. fVirginia reimburses for one month of care coordination, which has been divided by four for a weekly rate
  10. gWisconsin only covers 6 units of service per week, so the daily rate is multiplied by 6 rather than 7 as in other states. Wisconsin also only covers 39 units of H0003 per year, so it is multiplied by 3/4 to get a weekly rate