Insurance and billing issues

The cost of buprenorphine can vary depending on the dose. Cost of a dose of buprenorphine is determined by:

  • The pharmaceutical company, brand names and other companies that produce generic buprenorphine
  • The health plan
  • Retail pharmacies

Daily doses are normally from 8 mg to 24 mg (if using sublingual tablets), (Sullivan & Fiellin, 2008).

View ReferencesHide References
Blueshift Research. Camurus and Indivior Set to Significantly Sway the Opioid Abuse Treatment Market . Blueshift Research Report. 2017. Accessed on: 2017-03-21.
Sullivan, L, Fiellin, D. Narrative Review: Buprenorphine for Opioid-Dependent Patients in Office Practice. Annals of Internal Medicine. 2008; 148(9): 662-670. Available at: http://www.intnsa.org/resources/publications/position_june_2012.pdf Accessed on: 2015-12-04.
Related Resources: 
Description: 
This pie chart shows the breakdown of how buprenorphine patients paid for their doctor's visits. 204 patients in NAABT's physician-patient matching system were surveyed.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This study examines decision-making in the buprenorphine treatment distribution and payment systems. The study is based on interviews with health care leaders involved in the distribution and adoption of buprenorphine.
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The Center for Substance Abuse Treatment (CSAT)
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Billing

Related Resources: 
Description: 
Displays the appropriate CPT and HCPCS billing codes for the different phases of buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is an article written by CIGNA Behavioral Health's (CBH) Senior Medical Director. It describes how CIGNA addressed reimbursement, a major barrier to physician prescription of buprenorphine, by identifying an HCPCS code (H0033) that physicians can use to bill for the services provided during buprenorphine induction visits.
Source: 
Nemecek, Doug. Behavioral Healthcare: November 2007.
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Resource Type: 
Description: 
This study examines decision-making in the buprenorphine treatment distribution and payment systems. The study is based on interviews with health care leaders involved in the distribution and adoption of buprenorphine.
Source: 
The Center for Substance Abuse Treatment (CSAT)
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Resource Type: 

CoverageBuprenorphine treatment costs are typically not covered by Medicare unless the treatment is provided in an inpatient or outpatient treatment center. It may also be covered in some instances, such as during detoxification or early stage stabilization. However, the Medicare benefit does not usually cover typical office-based buprenorphine induction or maintenance treatment visits.

Related Resources: 
Description: 
This website offers comprehensive guidelines for treating patients who have substance use disorders.
Source: 
American Psychiatric Association (APA), 2006
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Physician stage in practice: 
Description: 
Displays the appropriate CPT and HCPCS billing codes for the different phases of buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is a database that allows users to search Medicare Prescription Coverage and Medicare Advantage Prescription Drug Plans by State.
Source: 
Department of Health and Human Services
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Description: 
This database allows physicians to search for local Medicare policies and relevant articles.
Source: 
US Department of Health and Human Services
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Description: 
This is the web format of a special addiction program by HBO. The material covers issues such as who pays for addiction treatment, and drug treatment for adolescents.
Source: 
Home Box Office, Inc., 2007
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Although there are few specific codes for billing for buprenorphine treatment (nor for all of addiction medicine), most private health insurance companies are now covering the cost of treatment. PCPs have been successfully using standard evaluation and management outpatient billing codes for both the induction and maintenance stages of treatment. 

Coding is either based on complexity of service or time, with four contributing components:

Related Resources: 
Description: 
Displays the appropriate CPT and HCPCS billing codes for the different phases of buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This clinical guidance from the PCSS-MAT provides a list of commonly used CPT codes for buprenorphine induction and maintenance. Information is includes for both psychiatrists and non-psychiatrist physicians.
Source: 
PCSS-MAT
field_vote: 
Description: 
This is an article written by CIGNA Behavioral Health's (CBH) Senior Medical Director. It describes how CIGNA addressed reimbursement, a major barrier to physician prescription of buprenorphine, by identifying an HCPCS code (H0033) that physicians can use to bill for the services provided during buprenorphine induction visits.
Source: 
Nemecek, Doug. Behavioral Healthcare: November 2007.
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Resource Type: 
Description: 
Describes CPT codes for urine drug testing as of March 2013
Source: 
Physicians Office Resource
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Description: 
This clinical guidance from the PCSS-MAT provides a list of commonly used CPT codes for buprenorphine induction and maintenance. Information is includes for both psychiatrists and non-psychiatrist physicians.
Source: 
PCSS-MAT
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Commonly Used CPT codes - Primary Care

Description: 
This is a table containing common CPT codes used by primary care physicians for buprenorphine treatment reimbursement.

Coding is either based on complexity of service or time, with four contributing components:

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Description: 
This clinical guidance provides information on billing services for office-based opioid treatment, including CPT codes for both psychiatrists and primary care providers.
Source: 
Physician Clinical Support System (PCSS)
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Physician stage in practice: 
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