CO · guidance
CO HCPF Physician-Administered Drugs (PAD) Billing Manual — Opioid Treatment Providers: Take-Home Buprenorphine
OpioidTreatmentProviders:Take-HomeBuprenorphine
EffectiveMay1,2023,opioidtreatmentproviders(OTPs)maydispenseuptoaseven-daysupplyoftake-homeoralbuprenorphineandbuprenorphinecombinationproducts.
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Thetake-homesupplyofuptoseven(7)daysmaybebilledasaPADthroughthemedicalbenefitviastandardbuy-and-billprocesseswhenanOTP:
ObtainstheappropriateDrugEnforcementAdministration(DEA)registration
HasauthoritybasedontherulesandregulationssetforthbytheStateofColorado
FollowsallguidelinessetforthbytheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)
OTPsmustbeenrolledwithHealthFirstColoradoasPT64:SubstanceUseDisorder–ClinicandbillfortheHCPCS/NDCofthebuprenorphineorbuprenorphinecombinationproductdispensedtothemember.
In-office:TheOTPmustbillfortheoffice-administeredoralbuprenorphineorbuprenorphinecombinationPADs,alongwithanyadditionalprocedurecodesasapplicable,forthedateofservicewhenthePADwasadministeredandobservedinoffice.
Example:
In-OfficeAdministration
Claimline
1
ProcedureCode
J0572
NDC
NDCofPADadministeredandobservedtothememberandreimbursableforthedateofserviceperAppendixX
UnitedBilled
1
PlaceofService
11(Office)
FDOS
05/01/2023
TDOS
05/01/2023
Take-home:aseparatelinemustbeusedfortheamountdispensedasatake-homesupply.TheFromDateofService(FDOS)andToDateofService(TDOS)shouldstartthedayaftertheclinicvisitandrepresentthetotalnumberofdaysappropriatefortheamountdispensed.Thedatespanshallbenomorethansevendaysintotalandplaceofservicemustbehome(POS12).
Example:
Take-HomeSupply
Claimline
2
ProcedureCode
J0572
NDC
NDCofPADadministeredandobservedtothememberandreimbursableforthedateofserviceperAppendixX
UnitedBill
7
PlaceofService
12(Home)
FDOS
05/02/203
TDOS
05/08/2023
IftheHCPCSandNDCbilledonbothlinesisthesameandeitherlinedeniesforduplicate,OTPsmaybillmodifier76,inadditiontoanyotherapplicablemodifiers.
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Someoralbuprenorphineproductsmaybepreferredorsubjecttopriorauthorizationrequirementswhenbilledanddispensedthroughthepharmacybenefit.RefertothePreferredDrugList(PDL)andAppendixPlocatedonthePharmacyResourceswebpageforallpharmacybenefitpoliciesandproceduresoncontinuationofcareandallowingfortransitionfromtake-homesupplytooutpatientprescription.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
72c2a756a14599e71f7a2cbc7d605075a1ea7a6fecd4c0835276f5181062b064
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