Changes To Opioid Treatment Program (OTP) Bundle Rate Billing Requirements Effective November 3, 2025

Beginning November 3, 2025, all OTP bundle services must be billed under the Ambulatory Patient Group (APG) methodology. This requirement applies to all programs serving Medicaid and Personal Wellness Plan (HARP) members.

Transition Timeline:

• July 1, 2024: OASAS began a phased transition permitting providers to bill OTP bundle services using either the traditional OTP rate codes (7969–7976) or the APG methodology.
• November 4, 2024: All providers were expected to begin using APG billing exclusively for OTP bundle services.
  • Procedure codes under APG include: G2067, G2068, G2078, and G2079.
  • Providers may also opt to bill other appropriate APG procedure codes (e.g., H0020, 90834) in place of the bundled codes.
  • The APG methodology offers flexibility—providers may alternate between bundled and unbundled billing approaches on a weekly basis, depending on service delivery.
• Effective November 3, 2025: OTP bundle rate codes 7969–7976 will be deactivated (“zeroed out”) by OASAS.

Important Reminders:

Please ensure your billing systems are fully aligned with the APG methodology by November 3, 2025, to avoid claim denials or delays. Healthfirst strongly encourages providers to review their current billing workflows and make necessary updates ahead of this deadline.

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am–5:30pm.