Summary & Overview
HCPCS G2076: Intake and Care Planning for Opioid Treatment Programs
HCPCS Level II code G2076 represents comprehensive intake activities and initial medical examination with development of an individualized care plan in a Medicare-enrolled opioid treatment program. The code captures the clinical and coordination work that establishes treatment goals, documents harm-reduction and recovery support needs, and identifies medical, psychiatric, social, economic, housing, education, and vocational supports. Nationally, this code matters because it defines billing for a high-touch, multidisciplinary entry point into opioid use disorder treatment and care coordination, which affects access to services and program workflows across payers.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical scope captured by the code, typical sites of service and service type, common modifier usage where applicable, and practical context for billing intake and care planning services in opioid treatment programs. The publication also summarizes benchmarking and policy updates relevant to how payers reimburse intake and care planning in behavioral health and medication-assisted treatment settings. Clinical context provided clarifies what activities are encompassed by the code so providers and administrators can align documentation and workflows with billing requirements. Data not available in the input are called out where applicable.
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient presents to a Medicare-enrolled opioid treatment program seeking initiation of medication-assisted treatment for opioid use disorder. An appropriately licensed practitioner (physician, nurse practitioner, or physician assistant) performs an intake visit including an initial medical examination, review of substance use history, mental health screening, social needs assessment (housing, employment, legal issues), and identification of recovery supports. A standardized, evidence-based assessment (for example, an Addiction Severity Index or ASAM criteria screening) is administered to inform care planning. The practitioner documents the patient’s goals (e.g., achieve opioid abstinence, reduce harm, stabilize housing, return to work) and develops a mutually agreed-upon care plan that includes medication management, counseling referrals, harm reduction interventions (e.g., naloxone prescription, safer use education), and connections to vocational or social services as needed. Licensed or credentialed clinic staff may perform portions of the intake under practitioner supervision. The service is billed in addition to primary treatment codes using G2076 when documenting the comprehensive intake and care plan preparation required for admission to the opioid treatment program. Typical workflow includes registration, consent, assessment administration, medical exam, care plan development, documentation, and scheduling of follow-up treatment visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |