Office-Based MAT (OBOT)
Buprenorphine and naltrexone in a prescriber's office
E/M visits · drug codes · Medicaid modifier U5
Medicare: monthly bundles G2086–G2088
MAT Billing Services · Nevada · Office-Based Buprenorphine and Opioid Treatment Programs
MAT Billing Services in Nevada
Get paid for every induction, injection, and counseling session. Medication-assisted treatment billing for practices prescribing buprenorphine and programs dispensing methadone.
Nevada Medical Billing provides MAT billing services for psychiatry and primary care practices offering office-based buprenorphine, opioid treatment programs (OTPs) dispensing methadone, and addiction treatment programs across Nevada. We bill every part of medication-assisted treatment: induction and maintenance visits, long-acting injectables like Sublocade, Brixadi, and Vivitrol, Medicare monthly and weekly bundles, Nevada Medicaid methadone services, counseling, and drug testing. We bill Nevada Medicaid and its five managed care plans, Medicare, Medicare Advantage, TRICARE, and commercial payers.
HIPAA and 42 CFR Part 2 compliant · No obligation
Find the MAT Revenue You're Missing
Share a few details and a MAT billing specialist will review your visits, injectable drug claims, and denials with you.
Office-based and OTP billing under one teamMedicare MAT bundles billed correctlyInjectable drug claims with NDCs and unitsHIPAA and 42 CFR Part 2 compliantOffice-based and OTP billing under one teamMedicare MAT bundles billed correctlyInjectable drug claims with NDCs and unitsHIPAA and 42 CFR Part 2 compliant
- Office-based and OTP billing
- Nevada Medicaid modifier U5 applied
- Injectable claims with NDCs
- 95%+ clean claims target
MAT billingWhy MAT Billing Is Different
Why MAT Billing Is Different
From Other Addiction Billing
MAT billing is different because medication-assisted treatment is billed two completely different ways depending on where it's delivered. A psychiatry or primary care practice prescribing buprenorphine bills office visits, injectable drugs, and (for Medicare) monthly treatment bundles. A certified opioid treatment program dispensing methadone bills weekly bundles to Medicare and per-dose or per-diem codes to Medicaid. Each payer adds its own drug rules, prior authorizations, and quantity limits, and Nevada Medicaid requires its own modifier on every MAT claim.
One treatment, two billing models
Medication-assisted treatment · medication plus counseling for OUD
Opioid Treatment Program (OTP)
Methadone, buprenorphine, and naltrexone
Certified by SAMHSA · registered with DEA
Medicare: weekly bundles G2067–G2080
Get My Free MAT Billing Audit
HIPAA and 42 CFR Part 2 compliant · No obligation
MAT billingWhere MAT Programs
Where MAT Programs
Lose Revenue
Missing Nevada Medicaid Modifier U5
Nevada Medicaid requires modifier U5 and an opioid use disorder diagnosis on each MAT claim. Visits billed without it are processed as routine office visits or denied.
Injectable Drug Claims Without NDCs or Correct Units
Long-acting buprenorphine and naltrexone injections are expensive. A missing National Drug Code, wrong units, or a missing administration code turns a high-dollar line into a denial.
Medicare Monthly Bundles Left Unbilled
Many office-based practices bill only E/M visits for Medicare patients and never use the monthly OUD treatment bundles (G2086–G2088) when counseling and care coordination support them.
Prior Authorizations and Step Therapy
Commercial plans often require prior authorization, step therapy (oral before injectable), or quantity limits for MAT drugs. Starting an injectable before approval leaves the practice holding the drug cost.
OTP Weekly Bundles Billed Incorrectly
Medicare OTP claims are built from weekly drug and non-drug bundles, plus add-ons for intake, assessments, take-home doses, and extra counseling. Missing add-ons or overlapping weeks lose revenue every month.
Counseling and Drug Testing Without Support
MAT counseling and urine drug testing are billable, but only with documentation that supports the service and its frequency. Routine definitive testing without a clinical reason is a common audit finding.
MAT billingOffice-Based MAT Billing
Office-Based MAT Billing
(Buprenorphine and Naltrexone)
Office-based opioid treatment (OBOT) is MAT delivered by a prescriber in a psychiatry, primary care, or addiction medicine practice. Since the federal X-waiver was eliminated in 2023, any prescriber with a DEA registration for Schedule III drugs can treat opioid use disorder with buprenorphine, so many practices are adding MAT for the first time.
| Visit phase | Common codes | What we get right |
|---|---|---|
| Screening and brief intervention | H0049 (screening), 99408/99409 (with brief intervention) | Nevada Medicaid allows one unit of one SBIRT code per new patient |
| Pre-induction evaluation | 99205 (new) or 99215 (established) | Documentation of suitability for buprenorphine |
| Induction | New or established E/M (99202–99215), consults 99242–99245 where payers accept them, 99417 for prolonged time | Level supported by time or medical decision making |
| Maintenance | 99212–99215, plus psychotherapy add-ons when therapy is separately documented | OUD diagnosis on every claim; modifier U5 for Nevada Medicaid |
| Medicare monthly OUD bundle | G2086 (first month, at least 70 minutes), G2087 (later months, at least 60 minutes), G2088 (each added 30 minutes past 120) | At least one psychotherapy service in the month; no double-billing of the same time |
| Long-acting injections | Q9991/Q9992 (Sublocade), J0577/J0578 (Brixadi), J2315 (naltrexone), plus 96372 administration where payers allow | NDC, units, and authorization on every claim |
Telehealth: Medicare allows the monthly OUD bundles by telehealth, and audio-only when video isn't available. Payers set their own rules for MAT visits by telehealth, which we verify per plan. psychiatry billing services · primary care billing services
MAT billingOpioid Treatment
Opioid Treatment
Program (OTP) Billing
Opioid treatment programs are certified by SAMHSA under 42 CFR Part 8, registered with the DEA, and approved by the state. They are the only setting that can dispense methadone for opioid use disorder, and they bill very differently from office practices.
| OTP billing element | Medicare | Nevada Medicaid and commercial |
|---|---|---|
| How care is billed | Weekly bundles of drug and services | Per-dose, per-diem, or per-service codes, by payer |
| Methadone | G2067 (weekly bundle) | H0020 (methadone administration) or payer-specific codes |
| Buprenorphine and naltrexone | G2068 (oral buprenorphine), G2069 (injectable buprenorphine), G2073 (naltrexone) | Drug and administration codes per payer |
| Services without drug | G2074 (non-drug bundle) | Counseling codes (such as H0004, H0005) per payer |
| Add-ons | G2076 (intake), G2077 (periodic assessment), G2078/G2079 (take-home supplies), G2080 (added counseling), G1028 (naloxone) | Per payer |
| Counseling and testing | Included in the weekly bundle | Often billed separately |
What we get right on OTP claims: one bundle per patient per week with no overlapping weeks, the right drug bundle for each medication, every eligible add-on captured, and take-home supply weeks documented.
MAT billingMAT Medications
MAT Medications
and How Each Is Billed
| Medication | Common brand names | Where it's given | How it's billed |
|---|---|---|---|
| Oral buprenorphine/naloxone | Suboxone, Zubsolv | Office-based or OTP | Usually prescribed through the pharmacy benefit; Nevada Medicaid office-supplied doses use J0571–J0575 with NDC |
| Oral buprenorphine (mono) | Generic | Office-based or OTP | Same as above; Nevada Medicaid prefers the mono product for pregnant patients |
| Extended-release buprenorphine injection | Sublocade, Brixadi | Office-based or OTP | Sublocade: Q9991 (100 mg or less) or Q9992 (more than 100 mg). Brixadi: J0577 (7 days or less) or J0578 (more than 7 days). With NDC; buy-and-bill or specialty pharmacy |
| Extended-release naltrexone injection | Vivitrol | Office-based or OTP | J2315 per 1 mg, with NDC and administration code per payer |
| Methadone | Generic | OTP only | Medicare G2067; Medicaid H0020 or payer-specific codes |
| Naloxone | Narcan | Any setting | G1028 (Medicare OTP) or pharmacy benefit |
Diagnosis codes for MAT drug claims must support opioid use disorder (such as F11.20–F11.29); naltrexone for alcohol use disorder is coded to F10.x.
MAT billingOur MAT Billing
Our MAT Billing
Services
We manage the full MAT revenue cycle for office-based practices and opioid treatment programs.
MAT Benefits Verification
We confirm coverage for each medication, medical vs pharmacy benefit, prior authorization and step therapy rules, quantity limits, copays, and behavioral health carve-out routing before the first visit. Eligibility Verification
Prior Authorization for MAT Drugs
We request approvals for injectables and higher doses with diagnosis, treatment history, and clinical rationale, track renewal dates, and appeal step therapy and quantity-limit denials. Prior Authorization
Visit Coding by Treatment Phase
We code screening, pre-induction, induction, and maintenance visits to documentation, apply modifier U5 for Nevada Medicaid, and capture psychotherapy add-ons when separately documented.
Medicare Monthly and Weekly Bundles
We bill Medicare's office-based OUD bundles (G2086–G2088) for practices and weekly OTP bundles with every eligible add-on for treatment programs.
Injectable Drug Billing and Reconciliation
We bill long-acting buprenorphine and naltrexone with the right HCPCS code, NDC, units, and administration code, and reconcile buy-and-bill inventory to paid claims.
Counseling and Drug Testing
We bill MAT counseling and urine drug testing only with documentation that supports the service and frequency. substance abuse billing services
Clean Claim Submission
Claims are scrubbed for modifier U5, OUD diagnosis, NDCs, bundle overlaps, and payer edits, then submitted within 48 hours.
Denial Management and Appeals
We appeal authorization, medical necessity, and drug-coding denials, and use parity rules when MAT coverage is more restrictive than medical benefits. Denial Management
Payment Posting and A/R Follow-Up
We post payments daily, flag drug and bundle underpayments, and work open claims by value and filing deadline. Payment Posting · AR Follow-Up
MAT Program Launch and Credentialing
Adding buprenorphine to your practice or opening an OTP? We handle payer enrollment, drug-model decisions, coding setup, and documentation templates before your first patient. Credentialing
MAT billingNevada Medicaid
Nevada Medicaid
MAT Billing Rules
Nevada Medicaid publishes specific MAT billing instructions, updated in August 2026, and we build every Medicaid MAT claim around them:
01
Policy: MAT services follow Medicaid Services Manual Chapter 3800, with prescribed drugs under Chapter 1200 and physician services under Chapter 600.
02
Eligible providers: prescribers with a DEA registration who meet Chapter 3800 requirements.
03
No prior authorization for MAT initiation and maintenance, or for the biopsychosocial assessment.
04
Modifier U5 and an opioid use disorder diagnosis are required on each MAT claim.
05
Visit codes by phase: SBIRT (H0049, 99408, 99409; one unit per new patient), pre-induction (99205 or 99215), induction (E/M, consults 99242–99245, prolonged 99417), and maintenance (99212–99215).
06
Office-supplied oral buprenorphine: J0571–J0575 with the NDC, and an OUD diagnosis such as F11.20–F11.29.
07
Coverage limit: buprenorphine prescribed for anything other than opioid use disorder isn't covered under MAT.
08
Managed care: most members are in one of five MCOs (Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit), each with its own pharmacy and authorization processes.
Let's talkFind the MAT Revenue
Find the MAT Revenue
You're Leaving Behind
01
Modifier U5 and OUD diagnosis check on Medicaid claims
02
Injectable drug NDC, units, and authorization review
03
Medicare bundle opportunity analysis
Get My Free MAT Billing Audit →
HIPAA and 42 CFR Part 2 compliant · No obligation
MAT billingMAT Denials We Prevent
MAT Denials We Prevent
and Overturn
| Denial cause | How we resolve it |
|---|---|
| Nevada Medicaid claim missing modifier U5 or OUD diagnosis | Add U5 and the correct F11 diagnosis, then resubmit |
| Injectable denied for missing NDC or wrong units | Add NDC and correct units to the drug line and resubmit |
| Wrong drug code for the product (for example, Sublocade billed with Brixadi codes) | Recode to the product's HCPCS code and dose range |
| No prior authorization or step therapy not met | Request retro-authorization where allowed; appeal with clinical history and parity rules |
| Quantity limit exceeded | Request a dose exception with documented clinical need |
| Medicare monthly bundle billed without psychotherapy or minimum time | Rebill as visits, or document the required services for future months |
| OTP weekly bundles overlap or wrong drug bundle used | Correct the week and bundle, then resubmit |
| Drug testing not medically necessary | Supply clinical rationale or adjust testing frequency going forward |
MAT billingMAT Billing for Every
MAT Billing for Every
Type of Provider
| Provider type | What we handle for you |
|---|---|
| Psychiatry practices prescribing buprenorphine | MAT visits alongside medication management and psychotherapy add-ons |
| Primary care and family medicine practices | Office-based MAT, SBIRT, and Medicare monthly bundles |
| PMHNP and PA-led clinics | MAT billing under each prescriber's NPI and DEA registration |
| Addiction medicine practices | Full MAT revenue cycle, including injectables |
| Opioid treatment programs (methadone clinics) | Medicare weekly bundles, Medicaid methadone billing, take-home doses |
| Treatment centers offering MAT inside IOP, PHP, or residential care | MAT billed correctly alongside program per diems |
| FQHCs and community health centers | MAT within encounter-based billing rules |
| Practices starting MAT | Launch support from enrollment to first paid claim |
MAT billingNevada Payers
Nevada Payers
We Bill for MAT
| Payer category | Plans |
|---|---|
| Nevada Medicaid | Fee-for-service MAT under MSM Chapter 3800, with modifier U5 |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Medicare | Noridian Healthcare Solutions (Jurisdiction E): office-based bundles and OTP benefit |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, and other MA plans |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare/Optum, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Behavioral health carve-outs | Vendors that manage SUD benefits for commercial plans |
| Military | TRICARE |
MAT billingWe Work Inside
We Work Inside
Your EHR
We bill MAT in the systems practices and OTPs use, including methadone dispensing systems such as Methasoft, plus Kipu, Sunwave, Lightning Step, AdvancedMD, athenahealth, eClinicalWorks, DrChrono, Tebra/Kareo, and Valant. No software change needed. EHR Integration
MAT billingHow We Take Over Your MAT
How We Take Over Your MAT
Billing in 2–4 Weeks
01
Free MAT billing audit: We review 90 days of MAT visits, drug claims, bundles, authorizations, and denials.
02
Secure setup: We sign a BAA and 42 CFR Part 2 terms, then connect to your EHR, clearinghouse, and payer portals.
03
Payer and drug mapping: We confirm each payer's visit codes, drug codes, NDC rules, authorizations, and Medicaid modifier requirements.
04
Authorization inventory: Active injectable and high-dose approvals go into tracking with renewal dates.
05
Go-live: Daily coding, drug reconciliation, and claim submission begin.
06
Legacy A/R cleanup: We work old MAT claims in parallel, starting with unpaid drug lines.
07
Monthly review: KPI report and a call with your dedicated account manager.
MAT billingWhat Results Can
What Results Can
Your MAT Program Expect?
These are the performance standards we manage your MAT revenue cycle to, based on industry best practices.
| KPI | What it measures | Best-practice target |
|---|---|---|
| First-pass clean claim rate | MAT claims paid without rework | 95% or higher |
| Denial rate | Claims denied on first submission | Under 5% |
| Days in A/R | Average time from service to payment | Under 35 days |
| Drug line accuracy | Injectable claims with correct code, NDC, and units | Every claim |
| Medicaid MAT modifier compliance | Nevada Medicaid MAT claims with U5 and OUD diagnosis | Every claim |
| Claim submission | Time from service to claim sent | Within 48 hours |
What a Free MAT Billing Audit Typically Uncovers
01
Nevada Medicaid MAT visits billed without modifier U5
02
Injectable claims missing NDCs or billed with the wrong product code
03
Medicare patients eligible for monthly OUD bundles billed only as office visits
04
Injections given before prior authorization was approved
05
OTP weekly bundles missing intake, assessment, or take-home add-ons
06
Definitive drug tests billed without documented clinical need
MAT billingHow Much Do MAT
How Much Do MAT
Billing Services Cost?
MAT billing is usually priced as a percentage of monthly collections, commonly 4–9% for behavioral health. Office-based practices with mostly visit billing typically fall at the lower end; OTPs and practices with heavy injectable and authorization work fall higher. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
Get My Free MAT Billing Audit →
HIPAA and 42 CFR Part 2 compliant · No obligation
MAT billingIn-House Biller
In-House Biller
or Outsourced MAT Billing?
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| Nevada Medicaid MAT rules | Modifier U5 often missed | Built into every Medicaid claim |
| Injectable drug billing | NDC and unit errors common | Checked on every drug line |
| Medicare bundles | Rarely used | Billed when documentation supports them |
| Prior authorizations | Falls on clinical staff | Tracked by our team |
| Absences and turnover | Billing stops | Backup team keeps working |
| Cost | Salary, benefits, software | One fee tied to collections |
MAT billingWorried About Switching?
Worried About Switching?
Here's How We Remove the Risk
01
"Patients will miss doses during the switch." Active authorizations and renewal dates are loaded before go-live.
02
"Our cash flow will drop." We work old claims in parallel while new ones go out.
03
"Our patients' privacy is at risk." We follow HIPAA and 42 CFR Part 2 with role-based access.
04
"We're locked in." You're not. The agreement is month-to-month with 30-day notice.
MAT billingCompliance Standards
Compliance Standards
for MAT Billing
MAT billing follows CPT, HCPCS, and ICD-10-CM guidelines, CMS OTP and office-based OUD billing rules, Nevada Medicaid MSM Chapter 3800 and its MAT billing instructions, SAMHSA's OTP regulations (42 CFR Part 8), DEA requirements, payer drug policies, mental health parity rules, HIPAA, and 42 CFR Part 2.
MAT billingWhy Nevada MAT Providers
Why Nevada MAT Providers
Choose Nevada Medical Billing
01
Both settings, one team: office-based MAT and OTP billing.
02
Nevada Medicaid MAT rules applied: modifier U5, OUD diagnoses, J0571–J0575, and phase-based visit codes.
03
Drug revenue protected: every injectable billed with the right code, NDC, and units.
04
Medicare bundles captured: monthly office-based and weekly OTP bundles.
05
Behavioral health depth: MAT billed alongside psychiatry, IOP/PHP, and SUD programs.
06
No lock-in: Month-to-month agreement with 30-day notice.
MAT billingMAT Billing Services
MAT Billing Services
Across Nevada
01
Las Vegas: Opioid treatment programs, addiction medicine practices, and psychiatry and primary care practices prescribing buprenorphine. Las Vegas page
02
Henderson: Office-based MAT in psychiatry and family medicine practices. Henderson page
03
North Las Vegas: OTPs and community clinics serving many Nevada Medicaid MCO patients. North Las Vegas page
04
Reno: MAT providers serving Washoe County and rural northern Nevada. Reno page
05
Carson City: Office-based MAT and rural programs billing CareSource and SilverSummit. Carson City page
We also support MAT programs in Sparks, Pahrump, Elko, Fallon, and Mesquite, including telehealth MAT follow-ups.
Let's talkGet Paid for Every
Get Paid for Every
MAT Visit and Dose
We help Nevada MAT providers apply Medicaid's U5 rules, bill injectables correctly, capture Medicare bundles, and keep authorizations active.
Request a Free MAT Billing Audit
Call (631) 652-3106
Free 90-day review · No obligation · HIPAA and 42 CFR Part 2 compliant
Behavioral health billing servicesPsychiatry billing servicesSubstance abuse billing servicesPrimary care billing servicesIOP and PHP billing servicesQuestions
MAT Billing FAQs
MAT billing services manage the revenue cycle for medication-assisted treatment: benefits verification, prior authorization, visit and drug coding, Medicare bundles, claim submission, payment posting, denial appeals, and A/R follow-up for office-based practices and opioid treatment programs.
Opioid treatment programs are certified clinics that can dispense methadone and bill Medicare weekly bundles (G2067–G2080). Office-based practices prescribe buprenorphine or naltrexone and bill office visits, injectable drugs, and Medicare's monthly OUD bundles (G2086–G2088).
With E/M codes for pre-induction, induction, and maintenance visits, plus psychotherapy add-ons when therapy is separately documented. Nevada Medicaid requires modifier U5 and an opioid use disorder diagnosis on each MAT claim.
No. Nevada Medicaid doesn't require prior authorization for MAT initiation and maintenance, or for the biopsychosocial assessment, as long as medical necessity is documented.
It's the modifier Nevada Medicaid uses to identify MAT services. It goes on each MAT claim along with an opioid use disorder diagnosis.
Yes, if you provide at least 70 minutes of treatment in the first month (G2086) or 60 minutes in later months (G2087), including at least one psychotherapy service. G2088 covers each added 30 minutes past 120.
Sublocade uses Q9991 or Q9992 by dose, Brixadi uses J0577 or J0578 by duration, and Vivitrol uses J2315 per milligram. Each needs an NDC, correct units, and usually prior authorization from commercial plans.
Yes. We bill Medicare OTP weekly bundles with add-ons, and Nevada Medicaid and commercial methadone services under each payer's codes.
Yes. We handle payer enrollment, coding and drug-model setup, authorization workflow, and documentation templates before your first patient.
Most providers pay 4–9% of collections, depending on volume, setting, and injectable and authorization workload. We give a fixed quote after a free audit.