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, 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, certified under 42 CFR Part 8 by HHS through the Substance Abuse and Mental Health Services Administration (SAMHSA), and 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

This is the point most people get wrong, so it is worth stating precisely. 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 makes OTP care one of the few Part B benefits with no coinsurance.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 for any copayment, since the plan administers the benefit.1

Georgia's Medicaid program also covers medication-assisted treatment (MAT). A federal SUPPORT Act mandate, codified at Section 1905(a)(29) of the Social Security Act, requires state Medicaid programs to cover MAT, including methadone, along with the counseling and behavioral therapy provided with it. As enacted in 2018 that requirement was time-limited and would have expired September 30, 2025, but Section 201(a)(1) of the Consolidated Appropriations Act, 2024 (Public Law 118-42, enacted March 9, 2024) struck the end date, so the mandate is permanent and still in force. A state can be excused from it 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. This matters most for Georgians who qualify for both Medicare and Medicaid.5

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, which is why there is no separate charge for each piece.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 updates the actual payment amounts each year in the Physician Fee Schedule, and the rate has a medication component and a non-medication (counseling and overhead) component. Because the beneficiary owes no coinsurance, these amounts affect what Medicare pays the program, not what you pay out of pocket.

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. Because it is a Schedule II medication, federal law generally lets it be dispensed for OUD only through a SAMHSA-certified, DEA-registered OTP; it cannot be prescribed at a doctor's office or filled at a community pharmacy for the OUD indication. (The same drug, prescribed for chronic pain, follows the ordinary pharmacy rules; the difference is the indication.)2 Buprenorphine is more flexible: it can be dispensed at an OTP or prescribed by a practitioner and filled at a pharmacy. Naltrexone, an antagonist that blocks opioid effects rather than activating the receptor, is not a controlled substance and can be prescribed by any practitioner.

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. 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 published its first major overhaul of those rules since 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.6

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

• Expanded take-home methadone. Eligibility no longer turns on length of time in treatment alone, 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. 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 15 days of treatment, and no more than 28 days from 31 days of treatment, with the amount within each ceiling left to the program practitioner's discretion. That can turn daily clinic trips into a handful of visits a month.6
• Telehealth to start treatment. A program can now initiate buprenorphine through audio-only or audio-visual telehealth, and methadone through audio-visual telehealth, when a program physician decides an adequate evaluation can be done that way. 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. An in-person physical exam is no longer required just to begin.6

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, and relatively few clinicians obtained it. 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, filled at a nearby pharmacy under Part D, without the old waiver hurdle. That care follows standard Part B and Part D cost-sharing rather than the OTP bundle's $0 copay, but it is often the most accessible option in a rural county.1

Your treatment records are protected: 42 CFR Part 2

Fear of exposure keeps some people from seeking treatment, so it helps to know the law is on your side. Substance use disorder records get heightened confidentiality protection under 42 CFR Part 2, which is more stringent than HIPAA alone. On February 16, 2024, HHS (through SAMHSA and the Office for Civil Rights) published a final rule that aligns Part 2 more closely with HIPAA. It took effect April 16, 2024, and its compliance date, February 16, 2026, has now passed, so the changes are fully in force. Among other changes, a single patient consent can now permit future uses and disclosures for treatment, payment, and health care operations, rather than requiring a separate consent each time, which makes coordinating your care easier without giving up the special protection.3

Finding a Georgia Medicare Opioid Treatment Program

Georgia has SAMHSA-certified OTPs concentrated in and around Atlanta and in other metro areas, with mobile medication units and take-home dosing helping to reach rural counties. 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. Know what that line does and does not do before you dial. 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.9

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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.