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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyBeacon Health Options Brixadi Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentBeacon-Health-OptionsPolicy N/A

    Updated Coverage of Brixadi for Opioid Use Disorders

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    Maryland Medicaid BHASO coverage and reimbursement for provider-administered Brixadi for opioid use disorder by eligible opioid treatment, community-based substance use disorder, and local health department providers.

    Policy Summary
    PayerBeacon-Health-Options
    PolicyUpdated Coverage of Brixadi for Opioid Use Disorders
    Policy CodePolicy N/A
    Change TypeNew coverage and reimbursement rate update
    Effective DateJanuary 1, 2025
    Next Review DateN/A
    Key ActionPurchase Brixadi from the manufacturer and administer it directly to the patient before submitting a reimbursement claim.
    SourceLink
    POLICY UPDATE CHANGES

    Effective January 1, 2025, Medicaid implemented BHASO coverage for Brixadi for opioid use disorder.

    The transmittal updates reimbursement rates for the Brixadi billing codes.

    This transmittal supersedes prior transmittal PT 56-25.

    3eligible provider types
    2Brixadi procedure codes
    7applicable Brixadi NDC codes
    $428.66

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    J0577 reimbursement rate
    $1,714.63J0578 reimbursement rate

    Covered Provider-Administered Brixadi

    Covered Provider-Administered Brixadi

    Brixadi is covered when ALL of the following criteria are met:

    ALL of the following

    • The service is provided on or after January 1, 2025, under BHASO coverage for opioid use disorder.

    • Eligible provider type

      • Opioid Treatment Program (OTP), Provider Type 32.
      • Community-based Substance Use Disorder Service Program, Provider Type 50.
      • Local Health Department, Provider Type 35.
    • The provider purchased Brixadi from the manufacturer and administers it directly to the patient.

    • Billing requirements

      • Bill using the applicable Brixadi procedure code: J0577 — buprenorphine extended-release injection (Brixadi), less than or equal to 7 days of therapy; rate effective January 1, 2025: $428.66.
      • Bill using the applicable Brixadi procedure code: J0578 — buprenorphine extended-release injection (Brixadi), greater than 7 days of therapy; rate effective January 1, 2025: $1,714.63.
      • Use the applicable NDC for the product administered: 58284-208-01 — Brixadi Weekly 8 mg/0.16 mL; 58284-216-01 — Brixadi Weekly 16 mg/0.32 mL; 58284-224-01 — Brixadi Weekly 24 mg/0.48 mL; 58284-232-01 — Brixadi Weekly 32 mg/0.64 mL; 58284-264-01 — Brixadi Monthly 64 mg/0.18 mL; 58284-296-01 — Brixadi Monthly 96 mg/0.27 mL; 58284-228-01 — Brixadi Monthly 128 mg/0.36 mL.
    • The claim is for provider-administered Brixadi; BHASO will not reimburse the J-codes when the medication is prescribed or when it is obtained from a pharmacy at the point of sale.

      For billing questions, contact Carelon at Provider.relations.MD@carelon.com. For questions about the coverage alert, contact mdh.mabehavioralhealth@maryland.gov.

    Brixadi Coding and Reimbursement

    Brixadi procedure codes and reimbursement ratesHCPCSCovered
    J0577Buprenorphine extended-release injection (Brixadi), less than or equal to 7 days of therapy; rate effective January 1, 2025: $428.66
    J0578Buprenorphine extended-release injection (Brixadi), greater than 7 days of therapy; rate effective January 1, 2025: $1,714.63
    Applicable Brixadi National Drug CodesNDCCovered
    58284-208-01BRIXADI WEEKLY 8 MG/0.16ML
    58284-216-01BRIXADI WEEKLY 16MG/0.32ML
    58284-224-01BRIXADI WEEKLY 24MG/0.48ML
    58284-232-01BRIXADI WEEKLY 32MG/0.64ML
    58284-264-01BRIXADI MONTH 64 MG/0.18ML
    58284-296-01BRIXADI MONTH 96 MG/0.27ML
    58284-228-01BRIXADI MONTH 128MG/0.36ML
    J-code reimbursement exclusionsHCPCSNot Covered
    J0577Not reimbursable when the medication is prescribed or obtained from a pharmacy at point of sale
    J0578Not reimbursable when the medication is prescribed or obtained from a pharmacy at point of sale
    J0577 Therapy Duration
    Procedure codeJ0577
    Therapy durationLess than or equal to 7 days of therapy
    Rate effective January 1, 2025$428.66
    J0578 Therapy Duration
    Procedure codeJ0578
    Therapy durationGreater than 7 days of therapy
    Rate effective January 1, 2025

    Provider Billing Requirements

    Billing Rule

    Eligible Provider Types

    Reimbursement is available only when Brixadi is administered by an eligible provider type.

    • Opioid Treatment Program (OTP) — Provider Type 32
    • Community-based Substance Use Disorder Service Program — Provider Type 50
    • Local Health Department — Provider Type 35
    Billing Rule

    Manufacturer Purchase and Direct Administration Required

    The provider must purchase Brixadi from the manufacturer and administer it directly to the patient before submitting a reimbursement claim.

    Eligible Provider Definitions

    Eligible Provider
    Reimbursement statusMay receive BHASO reimbursement for Brixadi
    Purchase sourceDrug purchased from the manufacturer
    AdministrationDrug administered directly to the patient
    OTP
    Full nameOpioid Treatment Program
    AbbreviationOTP
    Provider typeProvider Type 32
    Policy Summary
    PayerBeacon-Health-Options
    PolicyUpdated Coverage of Brixadi for Opioid Use Disorders
    Policy CodePolicy N/A
    Change TypeNew coverage and reimbursement rate update
    Effective DateJanuary 1, 2025
    Next Review DateN/A
    Key ActionPurchase Brixadi from the manufacturer and administer it directly to the patient before submitting a reimbursement claim.
    SourceLink
    On This Page
    Covered Provider-Administered BrixadiBrixadi Coding and ReimbursementProvider Billing RequirementsEligible Provider Definitions
    $1,714.63
    Eligible Provider Types
    Provider Type 32Opioid Treatment Program (OTP)
    Provider Type 50Community-based Substance Use Disorder Service Program
    Provider Type 35Local Health Department
    Denial Risk

    J-Code Billing Exclusion

    Do not bill the Brixadi J-codes when prescribing the medication or when the medication is obtained from a pharmacy at the point of sale.

    • J0577 — Buprenorphine extended-release injection (Brixadi), less than or equal to 7 days of therapy
    • J0578 — Buprenorphine extended-release injection (Brixadi), greater than 7 days of therapy
    Community-based Substance Use Disorder Service Program
    ProgramCommunity-based Substance Use Disorder Service Program
    Service settingCommunity-based
    Provider typeProvider Type 50
    Local Health Department
    ProviderLocal Health Department
    Provider typeProvider Type 35
    Eligible serviceBrixadi reimbursement when the drug is purchased from the manufacturer and administered directly to the patient