Summary & Overview
HCPCS G0532: Take-Home Nasal Nalmefene Supply
HCPCS Level II code G0532 designates the take-home supply of nasal nalmefene hydrochloride (one carton of two, 2.7 mg per 0.1 ml nasal sprays) furnished by a Medicare-enrolled opioid treatment program. This code captures the outpatient provision of an opioid overdose reversal medication intended for patient-administered use outside the clinic setting. Nationally, clarity on billing for take-home overdose reversal supplies matters for access, program workflows, and consistent payer handling.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, the service setting, and the code’s intended use. The publication summarizes what stakeholders need to know about coding and billing for take-home nasal nalmefene, outlines common modifiers associated with the code (input provided), and highlights areas where input data was not available.
The report provides benchmarks and policy-relevant context where available, explains typical service lines and sites of service, and identifies gaps in the input data, such as associated taxonomies and ICD-10 pairings. This summary is written for a national audience and focuses on operational and billing clarity rather than clinical guidance.
Billing Code Overview
HCPCS Level II code G0532 describes the take-home supply of nasal nalmefene hydrochloride, provided as one carton of two, 2.7 mg per 0.1 ml nasal sprays. The code applies to the provision of the medication and supply by a Medicare-enrolled opioid treatment program, and is reported in addition to each primary code for services rendered.
Service type: Medication supply (take-home nasal nalmefene) provided by an opioid treatment program.
Typical site of service: Opioid treatment program (OTP) or other enrolled outpatient substance use treatment setting.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A patient enrolled in a Medicare-participating opioid treatment program presents for a scheduled clinic visit following an opioid overdose reversal or as part of ongoing opioid use disorder management. The clinician assesses the patient’s risk for recurrent opioid overdose and documents medical necessity for take-home nalmefene nasal rescue medication. The program provides a take-home carton containing two 2.7 mg per 0.1 ml nasal sprays of nalmefene (one carton of two) and bills the supply separately using G0532 in addition to the primary visit or treatment codes. Typical workflow includes verification of Medicare enrollment, counseling on overdose recognition and nalmefene administration, documentation of informed consent and instructions, labeling and dispensing the take-home nasal spray, and entering the G0532 line-item charge when submitting claims. The typical site of service is an outpatient opioid treatment program or clinic enrolled in Medicare; dispensing occurs onsite at the treatment facility for patient possession at discharge or as a take-home supply.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | When no specific modifier applies to the service |