| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5000 |
Prescription drug, generic |
486,179 |
308,514 |
$105.11M |
| T1502 |
Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit |
536,201 |
327,039 |
$94.81M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
713,945 |
501,984 |
$72.19M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
861,322 |
482,399 |
$39.17M |
| G0483 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed |
225,125 |
131,168 |
$30.14M |
| G0482 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed |
243,891 |
168,366 |
$27.72M |
| H0014 |
Alcohol and/or drug services; ambulatory detoxification |
107,361 |
74,140 |
$26.68M |
| 90837 |
Psychotherapy, 53 minutes with patient |
126,416 |
97,533 |
$11.79M |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
140,587 |
77,193 |
$9.53M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
128,314 |
101,387 |
$8.53M |
| 90832 |
Psychotherapy, 30 minutes with patient |
154,251 |
124,232 |
$7.09M |
| H0006 |
Alcohol and/or drug services; case management |
238,656 |
169,800 |
$6.24M |
| 90834 |
Psychotherapy, 45 minutes with patient |
93,196 |
78,448 |
$5.80M |
| T2023 |
Targeted case management; per month |
19,577 |
17,259 |
$5.30M |
| 99406 |
|
440,882 |
330,942 |
$3.83M |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
43,847 |
29,487 |
$3.80M |
| H0020 |
Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) |
109,883 |
25,347 |
$3.03M |
| 80346 |
|
123,454 |
69,746 |
$2.12M |
| T1002 |
Rn services, up to 15 minutes |
58,866 |
44,324 |
$1.97M |
| 80361 |
|
126,838 |
71,605 |
$1.87M |
| J0574 |
Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine |
74,725 |
48,836 |
$1.72M |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13,174 |
11,907 |
$1.70M |
| T1007 |
Alcohol and/or substance abuse services, treatment plan development and/or modification |
33,829 |
30,638 |
$1.68M |
| 99205 |
Prolong outpt/office vis |
6,093 |
5,646 |
$1.18M |
| 80356 |
|
126,858 |
71,603 |
$1.04M |
| 80373 |
|
126,374 |
71,427 |
$1.04M |
| 80365 |
|
126,834 |
71,595 |
$1.03M |
| 80354 |
|
126,479 |
71,464 |
$1.03M |
| 80348 |
|
124,526 |
70,600 |
$1.03M |
| 80355 |
|
123,252 |
69,687 |
$1.02M |
| 80366 |
|
123,152 |
69,619 |
$1.01M |
| 80360 |
|
123,915 |
69,930 |
$1.01M |
| 80353 |
|
123,765 |
69,873 |
$1.00M |
| 80358 |
|
121,877 |
69,334 |
$1.00M |
| 80324 |
|
122,411 |
69,367 |
$994K |
| 81025 |
|
174,574 |
116,979 |
$983K |
| 80363 |
|
65,370 |
38,463 |
$977K |
| 80323 |
|
126,299 |
71,393 |
$967K |
| 80349 |
|
116,367 |
66,120 |
$960K |
| H0001 |
Alcohol and/or drug assessment |
16,485 |
14,965 |
$917K |
| 99215 |
Prolong outpt/office vis |
6,491 |
5,269 |
$879K |
| 80362 |
|
60,714 |
37,641 |
$850K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
37,083 |
30,341 |
$790K |
| 83992 |
|
64,886 |
38,303 |
$769K |
| T1003 |
Lpn/lvn services, up to 15 minutes |
33,069 |
25,659 |
$760K |
| H0015 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education |
6,053 |
2,337 |
$707K |
| 80336 |
|
77,017 |
45,014 |
$640K |
| 80334 |
|
77,045 |
45,030 |
$637K |
| 80359 |
|
73,388 |
42,876 |
$599K |
| 80371 |
|
70,764 |
41,477 |
$578K |
| 80372 |
|
65,211 |
38,400 |
$544K |
| 80367 |
|
65,207 |
38,393 |
$544K |
| 80368 |
|
64,841 |
38,152 |
$541K |
| 80369 |
|
64,533 |
37,992 |
$538K |
| J0572 |
Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine |
26,036 |
17,261 |
$533K |
| 80350 |
|
64,704 |
38,088 |
$532K |
| 80321 |
|
41,682 |
23,978 |
$474K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
6,939 |
4,938 |
$433K |
| 82075 |
|
16,430 |
12,992 |
$289K |
| H0038 |
Self-help/peer services, per 15 minutes |
14,530 |
9,686 |
$219K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
472 |
457 |
$50K |
| G2068 |
Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
1,177 |
667 |
$50K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,133 |
947 |
$44K |
| J0575 |
Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine |
1,954 |
1,027 |
$18K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
13 |
12 |
$17K |
| 90785 |
|
621 |
476 |
$7K |
| 93000 |
|
449 |
428 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
325 |
312 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
60 |
59 |
$5K |
| 80305 |
|
809 |
558 |
$4K |
| H0048 |
Alcohol and/or other drug testing: collection and handling only, specimens other than blood |
265 |
248 |
$4K |
| J0571 |
Buprenorphine, oral, 1 mg |
356 |
161 |
$4K |
| H0012 |
Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) |
20 |
13 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
103 |
102 |
$2K |
| G2074 |
Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) |
23 |
17 |
$2K |
| 80345 |
|
186 |
170 |
$1K |
| J0573 |
Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine |
486 |
211 |
$1K |
| 80332 |
|
123 |
65 |
$1K |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$1K |
| G2087 |
Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month |
36 |
24 |
$1K |
| 90839 |
|
15 |
13 |
$933.62 |
| G2077 |
Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code |
943 |
592 |
$710.20 |
| 99407 |
|
380 |
302 |
$414.58 |
| G2079 |
Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure |
280 |
241 |
$243.24 |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
27 |
24 |
$0.00 |