Summary & Overview
HCPCS G1028: Take-Home Nasal Naloxone 2-Pack (8mg)
HCPCS Level II code G1028 represents the provision of a take-home nasal naloxone kit — a 2-pack of 8 mg per 0.1 ml nasal spray — supplied by a Medicare-enrolled opioid treatment program. The code matters nationally as naloxone distribution is a key public health intervention to reduce opioid overdose deaths and aligns payment reporting with programs that incorporate harm-reduction supplies into routine care. This code identifies the separate supply of naloxone in addition to the primary OTP procedure.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of what the code denotes, the clinical and service context for OTP-based naloxone distribution, and what to expect when this line item appears on claims. The publication highlights billing context and typical use cases, notes common modifiers when available, and explains where naloxone provision sits relative to primary OTP services.
The piece is intended for national audiences including billing managers, compliance officers, and clinical program leads. It clarifies the code’s purpose, typical site of service, and the role of take-home naloxone in opioid treatment workflows. Data not provided in the input — such as payer-specific reimbursement rates, associated taxonomies, and ICD-10 pairings — are noted as not available.
Billing Code Overview
HCPCS Level II code G1028 describes a take-home supply of nasal naloxone, specifically a 2-pack of 8 mg per 0.1 ml nasal spray, provided by a Medicare-enrolled opioid treatment program. The service type is medication supply for opioid overdose reversal provided as an adjunct to treatment services. The typical site of service is an opioid treatment program (OTP) or clinic setting where the program furnishes the take-home naloxone to the patient.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient enrolled in a Medicare‑approved opioid treatment program presents for a routine visit related to opioid use disorder management. The patient is assessed by program staff and is provided with a take‑home naloxone rescue kit consisting of a two‑pack of 8 mg per 0.1 mL intranasal naloxone spray. The kit is dispensed in conjunction with counseling on overdose recognition, naloxone administration, and safe storage. Typical workflow: intake or scheduled follow‑up visit → brief overdose education (documented) → confirmation of patient identity and consent for take‑home naloxone → medication packaging and labeling by program pharmacy or staff → documentation of medication lot numbers, expiration dates, and patient counseling in the medical record. Billing uses HCPCS code G1028 reported separately in addition to the primary visit or treatment procedure performed by the opioid treatment program.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default reporting when no modifier applies |
22 | Increased procedural services |