Georgia Medicare Opioid Treatment Program Coverage

If you or someone you love has Medicare and needs treatment for opioid use disorder in Georgia, that care is covered, confidential, and carries no copay. Since January 1, 2020, Medicare Part B has paid for Opioid Treatment Program (OTP) services under Section 1861(jjj) of the Social Security Act, added by Section 2005 of the SUPPORT for Patients and Communities Act and implemented at 42 CFR 410.67. Georgia beneficiaries in Original Medicare pay $0 in coinsurance or copayments for OTP care at a Medicare-enrolled program, though the annual Part B deductible ($283 in 2026) applies first, and Medicare Advantage enrollees should check their own plan's cost sharing.1 This guide explains what the Georgia Medicare Opioid Treatment Program benefit covers, which medications qualify, how your records are protected, and how to find a program near you.

How Georgia Medicare covers Opioid Treatment Program services

For most of Medicare's history, beneficiaries with opioid use disorder (OUD) were in a hard spot. Medicare covered hospital care and some office-based treatment, but it did not pay for services at Opioid Treatment Programs, the SAMHSA-certified clinics that are, outside a hospital or nursing home stay, generally the only places allowed to dispense methadone for OUD. A retired Georgian who developed OUD after surgery could not use Medicare to pay for methadone maintenance, and self-pay costs put treatment out of reach for many people on fixed incomes.

Congress closed that gap. Section 2005 of the SUPPORT for Patients and Communities Act (Public Law 115-271) added Section 1861(jjj) to the Social Security Act, creating a new Part B benefit category for OUD treatment services furnished by an OTP, effective for services on or after January 1, 2020. CMS implemented the benefit at 42 CFR 410.67.1

The covered service list has grown since 2020. As 42 CFR 410.67(b) reads today, "opioid use disorder treatment service" covers eleven categories:

• FDA-approved opioid agonist and antagonist medications (methadone, buprenorphine, and naltrexone, including oral, injected, and implanted versions)
• Dispensing and administration of those medications
• Substance use counseling
• Individual and group therapy
• Toxicology (drug) testing
• Intake activities, including the initial medical examination
• Periodic assessment services
• FDA-approved opioid antagonist medications for the emergency treatment of a known or suspected overdose (naloxone, nalmefene), plus the overdose education furnished with them
• OTP intensive outpatient services
• Coordinated care and referral services
• Patient navigation and peer recovery support services

The last four were added after the benefit launched: CMS dates the overdose-antagonist category to January 1, 2021 and intensive outpatient services to January 1, 2024, and the coordinated-care and navigation/peer-support categories appear in the CMS Benefit Policy Manual chapter revised effective January 1, 2025. If a program tells you peer support or care coordination is not covered, that is out of date.1

To bill Medicare, an OTP must be enrolled in Medicare, hold a certification from the Substance Abuse and Mental Health Services Administration (SAMHSA), be accredited by a SAMHSA-approved accrediting body, and have a Medicare provider agreement.1 Under 42 CFR Part 8, it must also be registered with the Drug Enforcement Administration (DEA) before it administers or dispenses medications for opioid use disorder.2

What you pay for OTP care under Medicare

Under Original Medicare, your coinsurance and copayment for OTP services are $0: 42 CFR 410.67(e) states that "a beneficiary copayment amount of zero will apply," and Medicare.gov confirms that if you get these services from a Medicare-enrolled OTP that meets the requirements, you "won't have to pay any copayments." That zero copayment belongs to the OTP, not to the medication. Medicare.gov adds that if you get these services from a doctor or other health care provider instead, you'll pay copayments and the Part B deductible.1

The one cost that does apply is the annual Part B deductible. Medicare.gov is explicit: "The Part B deductible applies for these services, including any supplies and medications you might get as part of your treatment." In 2026 that deductible is $283, paid once for the year across your Part B services, after which OTP care costs you nothing. Two exceptions are worth knowing: if you have both Medicare and Medicaid and receive the care through Georgia Medicaid, you pay nothing at all; and if you are in a Medicare Advantage plan, check your plan's own cost sharing for OTP services.1

Medicaid has its own medication-assisted treatment (MAT) requirement. Section 1006(b) of the SUPPORT Act added MAT to the Medicaid benefit list at Section 1905(a)(29) of the Social Security Act, and CMS lists it among the mandatory benefits states are required to provide. The federal definition names methadone and includes the counseling services and behavioral therapy provided with the medication. As enacted in 2018 the provision ran only through September 30, 2025, but Section 201(a)(1) of the Consolidated Appropriations Act, 2024 (Public Law 118-42, enacted March 9, 2024) replaced that time-limited text, so it now carries no end date and did not lapse. A state can be excused only by certifying to the Secretary, at least every five years, that statewide implementation is not feasible because of a shortage of qualified MAT providers or facilities.5 Georgia has kept the benefit rather than claim that exception: CMS approved a Georgia Medicaid state plan amendment on December 19, 2025, effective October 1, 2025, that removes the scheduled end date for the state's required MAT program.5 This matters most for Georgians who qualify for both Medicare and Medicaid.

How the weekly bundled payment and its HCPCS codes work

Medicare does not pay an OTP fee-for-service the way it pays for an office visit. Section 1834(w) of the Social Security Act directs Medicare to pay the program 100 percent of a single bundled amount for an episode of care, and 42 CFR 410.67(b) defines that episode as one contiguous seven-day week. The bundle folds together the medication, its dispensing, counseling and therapy, and drug testing into one weekly payment, and separate add-on codes pay for extras such as intake, take-home doses, and additional counseling time.1

You may still see the OTP benefit described as "HCPCS codes G2067 through G2080." That shorthand is out of date and worth ignoring: G2070 through G2072 are no longer on the CMS list, and several current codes sit outside the range entirely. The current set, per the CMS Benefit Policy Manual Chapter 17 (Rev. 13572, issued March 3, 2026), looks like this.1

CMS assigns each weekly bundle code a flat dollar payment amount. Because you owe no copayment at a Medicare-enrolled OTP, those amounts affect what Medicare pays the program, not what you pay out of pocket beyond the Part B deductible.1

Which medications the OTP benefit covers

Medicare's OTP benefit covers all three medications the FDA has approved to treat OUD. The most important practical difference among them is where a Medicare patient can actually get each one.

Methadone carries the strictest rules. It is a federal Schedule II controlled substance.6 When it is used to treat OUD, it can generally be dispensed only through a SAMHSA-certified, DEA-registered OTP; it cannot be prescribed for OUD by an office-based practitioner or filled for OUD at an ordinary retail pharmacy. An OTP can, however, run medication units that are geographically separate from the clinic, including mobile units, where its practitioners, contractors, or community pharmacists dispense the medication.2 Buprenorphine is more flexible: it can be dispensed at an OTP or prescribed by any practitioner whose DEA registration includes Schedule III authority, if state law permits.7 Medicare Part B covers naltrexone, like buprenorphine, when you get it in a doctor's office as well as through an OTP.8

The hospital and nursing home exception. The OTP-only rule has one carve-out that matters a great deal to older adults, and it is easy to miss. Under 42 CFR 8.11(h)(3), OTP certification is not required to start or continue methadone treatment for a patient admitted to a hospital, a long-term care facility, or a correctional facility that is registered with the DEA as a hospital or clinic, when the patient was admitted for a medical condition other than opioid use disorder and needs methadone for OUD during the stay. In plain terms: if your parent is on methadone maintenance and goes into the hospital for a hip fracture or into a skilled nursing facility for rehab, the facility does not have to be a certified OTP to keep the methadone going. The carve-out waives OTP certification only; the facility still needs its own DEA registration. If a facility tells your family the medication must stop at the door, that is worth questioning.2

SAMHSA certification, take-home doses, and telehealth

Every OTP is certified and regulated by SAMHSA under 42 CFR Part 8. In 2024, SAMHSA updated standards that had been in place since those rules took effect in 2001. The final rule, "Medications for the Treatment of Opioid Use Disorder," appeared in the Federal Register on February 2, 2024 (89 FR 7528), took effect April 2, 2024, with a compliance date of October 2, 2024, and made permanent several flexibilities that began during the COVID-19 emergency.9

Two of those changes matter most to Georgia patients, especially in rural areas:

• Expanded take-home methadone. Time in treatment is no longer the only consideration, and programs no longer have to rely rigidly on toxicology results showing complete and sustained abstinence, so a patient may be eligible for unsupervised take-home doses based on the treating provider's clinical judgment, even upon entry into treatment. That judgment is structured: a licensed OTP medical practitioner or the medical director decides, weighing listed criteria such as regular attendance, no known recent diversion, and whether the doses can be safely transported and stored, and must document the decision in the medical record. For methadone, a graduated ceiling still applies under 42 CFR 8.12(i)(3): beyond doses for days the clinic is closed, the take-home supply is limited to 7 days during the first 14 days of treatment, 14 days from day 15 of treatment, and no more than 28 days from day 31, with the number of doses up to each ceiling set by the practitioner on those same criteria. Those ceilings do not apply to buprenorphine.9
• Telehealth to start treatment. A program can now start buprenorphine through audio-only or audio-visual telehealth when a practitioner determines an adequate evaluation can be done that way, and can start methadone for a new patient through audio-visual telehealth. For methadone, audio-only is acceptable only when audio-visual is not available and the patient is in the presence of a licensed practitioner registered to prescribe controlled medications. The in-person physical exam is deferred, not dropped: a full in-person physical examination must still be completed within 14 calendar days of admission to the program.9

The MAT Act and office-based buprenorphine

For years, a doctor needed a special DEA "X-waiver" (under the Drug Addiction Treatment Act of 2000) before prescribing buprenorphine for OUD. The Mainstreaming Addiction Treatment (MAT) Act, enacted as Section 1262 of the Consolidated Appropriations Act, 2023 (Public Law 117-328), eliminated that waiver on enactment in December 2022. Now any practitioner whose current DEA registration includes Schedule III authority may prescribe buprenorphine for OUD, if state law permits, and SAMHSA no longer accepts waiver applications. There is no longer a federal cap on how many OUD patients a practitioner may treat with buprenorphine.7

For a Georgian who lives far from an OTP, this is the practical opening: a local primary-care physician can now prescribe buprenorphine without the old waiver hurdle.7 Weigh the cost difference, though. Treatment from a doctor rather than an OTP does not get the OTP's $0 copayment: Medicare.gov says that care comes with copayments and the Part B deductible.1

Your treatment records are protected: 42 CFR Part 2

Fear of exposure keeps some people from seeking treatment, so it helps to know how the law protects you, and where that protection stops. Substance use disorder treatment records get special confidentiality protection under 42 CFR Part 2. Records from a federally assisted treatment program may be disclosed only for the purposes and in the circumstances the law expressly allows, and the protection continues after you stop being a patient.

The protection is strong but not absolute. The law allows disclosure without your consent to medical personnel in a genuine medical emergency, for research or audits that may not identify you, under a court order, or to a public health authority in de-identified form; it also does not block state-law reporting of suspected child abuse or neglect. Its firmest shield is against use in a case against you: without your consent or a court order, your records cannot be used in civil, criminal, administrative, or legislative proceedings against you, entered into evidence in a criminal prosecution, or used to apply for a warrant.

On February 16, 2024, HHS published a final rule that increases Part 2's alignment with the HIPAA Privacy Rule. It took effect April 16, 2024, and its requirements are now in the Code of Federal Regulations. The change families notice most: you can give a single consent for all future uses and disclosures for treatment, payment, and health care operations, rather than a separate consent each time, and you can revoke that consent in writing.3

Finding a Georgia Medicare Opioid Treatment Program

If the nearest clinic is a long drive away, ask whether the OTP runs a medication unit closer to you, including a mobile one, since federal rules let a certified program dispense from sites geographically separate from the clinic.2 Here is how to find and start care.

Georgia beneficiaries can reach the SAMHSA National Helpline at 1-800-662-HELP (4357), TTY 1-800-487-4889, for confidential, 24-hour treatment referrals and information in English and Spanish. The referral service is free of charge, and a caller with no insurance or too little of it is referred to the state office responsible for state-funded treatment programs, often to facilities that charge on a sliding fee scale or that accept Medicare or Medicaid. It is a referral and information service rather than a counseling or crisis line: SAMHSA states plainly that it does not provide counseling, and its trained information specialists instead transfer callers to state services or other appropriate intake centers.4 For Medicare questions, GeorgiaCares, Georgia's State Health Insurance Assistance Program run by the Division of Aging Services, gives free and unbiased counseling at 1-866-552-4464, option 4, Monday through Friday from 8 a.m. to 5 p.m. Its certified counselors are not affiliated with any insurance company and do not sell insurance.11

Learn More

Find personalized help understanding Georgia Medicare coverage of opioid treatment at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.