CurrentMississippi Division of MedicaidPolicy N/A

Medication‑Assisted Treatment (MAT) — Coverage Criteria

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Defines Medicaid coverage, providers, services, limitations, and utilization controls for Medication‑Assisted Treatment (MAT) for beneficiaries in Mississippi under section 1905(a)(29). Applies to Medicaid beneficiaries meeting medical necessity criteria.

Policy Summary

PayerMississippi Division of Medicaid

PolicyMedication‑Assisted Treatment (MAT) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization for non‑preferred physician‑administered MAT drugs and for OTP services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

36Individual therapy sessions (non-OTP) / SFY

40Group therapy sessions (non-OTP) / SFY

24Family therapy sessions (non-OTP) / SFY

Effective Apr 1, 2021Prior auth required

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CurrentMississippi Division of MedicaidPolicy N/A

Medication‑Assisted Treatment (MAT) — Coverage Criteria

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerMississippi Division of Medicaid

PolicyMedication‑Assisted Treatment (MAT) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization for non‑preferred physician‑administered MAT drugs and for OTP services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

36Individual therapy sessions (non-OTP) / SFY

40Group therapy sessions (non-OTP) / SFY

24Family therapy sessions (non-OTP) / SFY

Effective Apr 1, 2021Prior auth required

10/01/2025Document effective date

Coverage Criteria for Medication-Assisted Treatment (MAT)

General MAT Coverage

Covered when the beneficiary meets medical necessity criteria.

General coverage requirements: MAT is covered under the Medicaid state plan for all Medicaid beneficiaries who meet the medical necessity criteria for receipt of the service for the period beginning October 1, 2020 and ending September 30, 2025.

Service Components

Covered service components as part of MAT:

Service components: Assessments related to the beneficiary's opioid use disorder; drug screenings; medication evaluation and management (face-to-face interactions for assessment, prescribing, and regular periodic monitoring); medication administration including FDA-approved drugs for treatment of opioid use disorder; individual therapy; group therapy; and family therapy.

These services are covered as part of the MAT service package.

Providers and Qualifications

Covered provider types and qualification requirements:

Provider types: Opioid Treatment Programs (OTPs) certified by the Mississippi Department of Mental Health for methadone; physicians, nurse practitioners, physician assistants, psychologists, licensed professional counselors (LPC), licensed clinical social workers (LCSW), and licensed marriage and family therapists (LMFT) for assessments, medication management, and therapy services as specified.

Provider qualifications: Providers must be licensed in Mississippi. Physicians, nurse practitioners, and physician assistants must be buprenorphine-waivered to prescribe, administer, or dispense buprenorphine. OTPs must be certified and are limited to entities that prescribe and dispense methadone.

These provider types are not eligible to enroll as OTPs unless certified as OTPs per state requirements.

Limits for Non-OTP Services

Limitations on services provided outside OTPs:

Non-OTP limits: MAT drugs and services provided through OTPs are not limited. Services provided outside of an OTP are limited as follows: individual therapy is limited to 36 sessions per state fiscal year; group therapy is limited to 40 sessions per state fiscal year; family therapy is limited to 24 sessions per state fiscal year.36, 40, 24 per SFY respectively

Effective April 1, 2021, prior authorization is required for non-preferred physician-administered drugs and OTP services.

General Coverage

Covered for beneficiaries who meet medical necessity

General coverage assurance: MAT is covered under the Medicaid state plan for all Medicaid beneficiaries who meet the medical necessity criteria for receipt of the service.

Coverage period specified: Oct 1, 2020 through Sep 30, 2025.

Service Package / Counseling and Behavioral Therapies

Covered service package components (as part of MAT)

Service components: Assessments related to OUD; drug screenings; medication evaluation and management (intentional face-to-face interactions for assessment, prescribing, and monitoring); medication administration including FDA-approved medications for OUD; individual, group, and family therapy.

These services are covered as part of the MAT service package; the state assures there will be no duplication of services through the MAT benefit and other State Plan services.

Provider Qualifications and Allowed Furnishers

Who may furnish services

Providers for assessments and medication management: Physicians, nurse practitioners, and physician assistants may provide assessments, medication management, medication evaluation and management, and medication administration. Physicians, NPs, and PAs must be buprenorphine-waivered to prescribe, administer, or dispense buprenorphine.

These providers are not eligible to enroll as OTPs unless certified as OTPs per state requirements.

Providers for therapy: Individual, group, and family therapy may be provided by physicians, nurse practitioners, physician assistants, psychologists, LPCs, LCSWs, or LMFTs. Family therapy involving a non-Medicaid participant must be for the direct benefit of the beneficiary.

Limits and Utilization Controls

Utilization controls and limits

Utilization controls: The state uses drug utilization controls including preferred drug lists and quantity limits. Clinical criteria and generic-first were not selected on the form.

These controls may apply to MAT medications and could trigger prior authorization or step therapy processes.

Session limits outside OTPs: Individual therapy is limited to 36 sessions per state fiscal year; group therapy is limited to 40 sessions per state fiscal year; family therapy is limited to 24 sessions per state fiscal year for services provided outside of an OTP.36, 40, 24 per SFY respectively

MAT drugs and services provided through OTPs are not limited.

OTP service scope: MAT drugs and services provided through OTPs are not limited.

OTPs must be certified by the Mississippi Department of Mental Health and provide methadone per 42 C.F.R. Part 8.

Covered MAT services and provider qualifications

Covered MAT components and provider types

Core MAT components: Covered components include assessments related to OUD; drug screenings; medication evaluation and management; medication administration including FDA-approved drugs for OUD; individual, group, and family therapy; and services provided through OTPs.

Based on Section 1905(a)(29) description and service package.

Provider types: OTPs certified by the Mississippi Department of Mental Health for methadone; physicians, nurse practitioners, physician assistants, psychologists, LPCs, LCSWs, and LMFTs provide specified services. Physicians, NPs, and PAs must be buprenorphine-waivered to prescribe, administer, or dispense buprenorphine.

OTPs are limited to prescribing and dispensing methadone and must be certified by the Mississippi Department of Mental Health.

MAT counseling and behavioral therapies

1 top-level node

MAT counseling and behavioral therapies: Individual therapy is limited to 36 sessions per state fiscal year for services provided outside of an OTP.36 sessions per SFY

MAT medications (naltrexone, buprenorphine, methadone)

1 top-level node

MAT medications: Coverage is assured for naltrexone, buprenorphine, and methadone and all approved formulations and biologicals; methadone for MAT must be provided through certified OTPs per 42 C.F.R. Part 8.

Physicians, NPs, and PAs must hold buprenorphine waivers to prescribe/administer/dispense buprenorphine.

Medication Assisted Treatment (MAT)

1 top-level node

Medication Assisted Treatment (MAT): Core MAT includes assessments related to OUD; drug screenings; medication evaluation and management; medication administration of FDA-approved OUD medications; individual, group, and family therapy; and services delivered through OTPs.

The state assures no duplication of services and limits apply for services provided outside OTPs.

MAT drugs and services provided through certified Opioid Treatment Programs (OTPs) are not limited. Services delivered outside of an OTP are subject to session limits: Individual therapy — 36 sessions per state fiscal year, Group therapy — 40 sessions per state fiscal year, and Family therapy — 24 sessions per state fiscal year. Additionally, effective April 1, 2021, prior authorization is required for non-preferred physician‑administered drugs and for OTP services.

OTPs are limited to entities that prescribe and dispense methadone and must be certified by the Mississippi Department of Mental Health. Physicians, nurse practitioners, and physician assistants who hold a buprenorphine waiver are not eligible to enroll as OTPs; these clinicians may prescribe, administer, or dispense buprenorphine only if they hold the required waiver and meet licensure requirements described by the state.

There are no limitations on MAT drugs and services provided through OTPs. The State explicitly assures that services delivered within certified OTPs — including methadone treatment — are not subject to the session limits that apply to services furnished outside of an OTP.

Treatment Modalities and Medications

MAT counseling and behavioral therapies

1 top-level node

MAT counseling and behavioral therapies: Individual therapy; group therapy; family therapy; assessments related to OUD; drug screenings; medication evaluation and management; medication administration including FDA-approved OUD medications.

These therapies are included as part of the MAT service package.

MAT medications (naltrexone, buprenorphine, methadone)

1 top-level node

MAT medications: The state assures coverage of naltrexone, buprenorphine, and methadone and all forms and formulations approved under applicable federal law; methadone for MAT must be provided by certified OTPs.

Buprenorphine prescribing requires a waiver for physicians, nurse practitioners, and physician assistants.

Medication Assisted Treatment (MAT)

Visit Limits for Non-OTP Settings

Individual therapy (non-OTP) — 36 sessions per state fiscal year

Limit36 individual therapy sessions per state fiscal year for services provided outside of an OTP.

ScopeApplies only to individual therapy provided outside of certified Opioid Treatment Programs (OTPs).

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Group therapy (non-OTP) — 40 sessions per state fiscal year

Limit40 group therapy sessions per state fiscal year for services provided outside of an OTP.

ScopeApplies only to group therapy provided outside of certified Opioid Treatment Programs (OTPs).

Prior Authorization, Documentation, and Utilization Controls

Prior Authorization

Prior authorization required for non-preferred physician‑administered drugs and OTP services

Prior authorization (PA) is required for non-preferred physician‑administered drugs and for services provided through Opioid Treatment Programs (OTPs), effective April 1, 2021.

Prior Authorization

Prior authorization requirement for non‑preferred MAT drugs and OTP services

Prior authorization is required for non‑preferred physician‑administered MAT drugs and for OTP services, with the PA requirement effective April 1, 2021.

Prior Authorization

PA required for non‑preferred drugs and OTP services; utilization controls in place

The State requires prior authorization for non‑preferred physician‑administered drugs and for OTP services; the State also maintains preferred drug lists, clinical criteria, and quantity limits as utilization controls.

Definitions and Covered Medications

MAT drugs covered — Naltrexone, Buprenorphine, and Methadone coverage assurance

Medications assuredNaltrexone, Buprenorphine, and Methadone and all forms approved under section 505 of the FD&C Act and biological products under section 351 of the PHS Act are covered.

FormulationsAll FDA-approved formulations and biologicals licensed under applicable federal statutes are included.

Methadone deliveryMethadone for MAT must be provided by certified Opioid Treatment Programs (OTPs) as assured by the state.

Opioid Treatment Program (OTP) — OTP certification and scope

CertificationOTPs must be certified by the Mississippi Department of Mental Health.

ScopeOTPs provide methadone treatment and prescribe and dispense methadone in accordance with 42 C.F.R. Part 8.

Background

This policy governs Medicaid coverage of Medication‑Assisted Treatment (MAT) for opioid use disorder under section 1905(a)(29). The State assures coverage of FDA‑approved medications for OUD — including naltrexone, buprenorphine, and methadone — and the associated counseling and behavioral therapy components. Methadone for MAT must be provided through certified Opioid Treatment Programs (OTPs); buprenorphine prescribing requires a buprenorphine waiver for physicians, nurse practitioners, and physician assistants. Coverage is provided for beneficiaries who meet medical necessity criteria for the period beginning October 1, 2020 and ending September 30, 2025.

Coding and Billing (Placeholders)

Covered providers include certified OTPs for methadone and a range of licensed clinicians for assessments, medication management, medication evaluation and management, medication administration, and therapy services. Specifically, physicians, nurse practitioners, and physician assistants may provide assessments, medication management, medication evaluation and management, and medication administration; these three clinician types must be buprenorphine‑waivered to prescribe, administer, or dispense buprenorphine. Individual, group, and family therapy may be provided by physicians, nurse practitioners, physician assistants, psychologists, LPCs, LCSWs, or LMFTs. Providers must be licensed in Mississippi, and OTPs must be certified by the Mississippi Department of Mental Health. For billing and program oversight, the State also uses drug utilization controls including preferred drug lists, clinical criteria, and quantity limits.

Revision History and Effective Dates

General coverage assurance: MAT is covered under the Medicaid state plan for all Medicaid beneficiaries who meet medical necessity criteria. The document shows an assurance period beginning October 1, 2020 and ending September 30, 2025. The State also specifies required provider qualifications (licensure, OTP certification, buprenorphine waiver where applicable) and affirms coverage of FDA‑approved MAT medications and the full MAT service package.

Prior authorization is required for non‑preferred physician‑administered drugs and for OTP services. The policy states that this prior authorization requirement became effective on April 1, 2021. Providers should anticipate that non‑preferred status, preferred drug list placement, clinical criteria, and quantity limits may trigger prior authorization or denial if documentation and criteria are not met.

Policy Summary

PayerMississippi Division of Medicaid

PolicyMedication‑Assisted Treatment (MAT) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization for non‑preferred physician‑administered MAT drugs and for OTP services.

SourceLink

On This Page

Medication Assisted Treatment (MAT): MAT comprises assessments, drug screenings, medication evaluation and management, medication administration of FDA-approved OUD medications, and psychosocial therapies (individual, group, family); services through OTPs are included and not subject to the non-OTP limits.

Providers must document services and follow state certification/waiver requirements as applicable.

MAT drugs and services provided through OTPs are not limited.

Family therapy (non-OTP) — 24 sessions per state fiscal year

Limit24 family therapy sessions per state fiscal year for services provided outside of an OTP.

ScopeApplies only to family therapy provided outside of certified Opioid Treatment Programs (OTPs).

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Individual therapy (outside OTP) — 36

Limit36 individual therapy sessions per state fiscal year for services provided outside of an OTP.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Group therapy (outside OTP) — 40

Limit40 group therapy sessions per state fiscal year for services provided outside of an OTP.

ReferenceListed under state-described limitations for services outside of an OTP.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Family therapy (outside OTP) — 24

Limit24 family therapy sessions per state fiscal year for services provided outside of an OTP.

ReferenceSpecified in the state's 'Limitations' section for non-OTP services.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Individual therapy (non-OTP) — 36 (duplicate source location)

Limit36 individual therapy sessions per state fiscal year for services provided outside of an OTP.

Effective dateLimit language shown in the document effective 10/01/2025.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Group therapy (non-OTP) — 40 (duplicate source location)

Limit40 group therapy sessions per state fiscal year for services provided outside of an OTP.

Effective dateLimit language shown in the document effective 10/01/2025.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Family therapy (non-OTP) — 24 (duplicate source location)

Limit24 family therapy sessions per state fiscal year for services provided outside of an OTP.

Effective dateLimit language shown in the document effective 10/01/2025.

OTP exceptionMAT drugs and services provided through OTPs are not limited.

Billing Rule

Drug utilization controls: PDLs, clinical criteria, and quantity limits

The State uses drug utilization controls including preferred drug lists, clinical criteria, and quantity limits to manage MAT drug use.

Preferred drug lists are used.
Clinical criteria are applied.
Quantity limits are applied.

Billing Rule

Preferred drug lists and quantity limits used (no generic‑first selection)

Preferred drug lists and quantity limits are implemented as part of the State's drug utilization controls; the form does not mark a generic‑first policy.

Generic‑first policy box is unchecked.

Step Therapy

Clinical criteria may implement step therapy

Clinical criteria used as part of the State's utilization controls may implement step‑therapy mechanisms, though specific step‑therapy rules are not detailed in the form.

Clinical criteria may require prior trials or other controls before coverage.

Note

PRA disclosure and OMB control information

The document includes a PRA (Paperwork Reduction Act) disclosure with OMB control number 0938-1148 (CMS-10398 #68); providers must follow required data collection and reporting as stated in the PRA statement.

OMB control number: 0938-1148 (CMS-10398 #68).
Public burden estimate and PRA contact information are provided.

Documentation Required

Document assessments, drug screenings, med eval/management, medication administration, and counseling

Providers must document assessments, drug screenings, medication evaluation and management (face‑to‑face interactions), medication administration, and counseling/therapy services as components of MAT.

Document assessments related to the beneficiary's opioid use disorder.
Document drug screening results and medication evaluation/management encounters.
Document medication administration and counseling/therapy provided.

Documentation Required

Required documentation for OUD assessments, med eval/management, medication administration, and counseling

Providers must maintain documentation supporting OUD assessments, medication evaluation and management (face‑to‑face), medication administration of FDA‑approved OUD drugs, and counseling services as applicable for each beneficiary.

Record face‑to‑face medication evaluation and management encounters.
Document that medication administration involves FDA‑approved drugs for OUD.

Denial Risk

PA required — risk of denial for non‑preferred physician‑administered drugs and OTP services

Prior authorization is required for non‑preferred physician‑administered drugs and for OTP services, effective April 1, 2021; claims for these services without PA risk denial.

Obtain PA before billing non‑preferred physician‑administered MAT drugs or OTP services provided on/after April 1, 2021.

Prior Authorization

Prior authorization triggers for non‑preferred physician‑administered drugs and OTP services

Prior authorization is triggered for non‑preferred physician‑administered drugs and for OTP services effective April 1, 2021; providers should request PA prior to service delivery to avoid denial.

PA must be in place for non‑preferred physician‑administered drugs and OTP services rendered on/after April 1, 2021.

Denial Risk

PA plus drug utilization controls — verify PDL, clinical criteria, and quantity limits to avoid denial

Prior authorization is required for non‑preferred physician‑administered drugs and OTP services effective April 1, 2021, and the State's preferred drug lists, clinical criteria, and quantity limits may cause denials if criteria are not met.

Verify PDL status and applicable clinical criteria before submitting PA.
Ensure requested quantities conform to State quantity limits.

Enrollment exclusionPhysicians, NPs, and PAs who are buprenorphine-waivered are not eligible to enroll as OTPs.

Buprenorphine waivered practitioner — Requirement for waiver for certain prescribers

Who must be waiveredPhysicians, nurse practitioners, and physician assistants must be buprenorphine-waivered to prescribe, administer, or dispense buprenorphine.

ImplicationThese waivered clinicians may provide assessments, medication management, evaluation and management, medication administration, and therapy but are not OTP enrollees.

LicensurePhysicians, NPs, and PAs must be licensed by the state of Mississippi in addition to holding the waiver.

Opioid Treatment Program (OTP) — Program definition per Mississippi Department of Mental Health and federal requirements

DefinitionAn Opioid Treatment Program (OTP) is a program certified by the Mississippi Department of Mental Health that prescribes and dispenses methadone and meets requirements in 42 C.F.R. Part 8.

Service limitationOTPs are limited to those that prescribe and dispense methadone and must be certified; other clinician types are not eligible to enroll as OTPs.

Regulatory basisOTP operations must comply with federal requirements in 42 C.F.R. Part 8.

Covered MAT medications — Naltrexone, buprenorphine, methadone and FDA-approved formulations

Covered medicationsNaltrexone, Buprenorphine, and Methadone are covered, including all FDA-approved formulations and biologicals for OUD.

Assurance languageThe state assures coverage for all formulations of MAT drugs and biologicals approved under section 505 and licensed under section 351.

OTP deliveryMethadone coverage is tied to OTP provision per state assurance.

Medication Evaluation and Management — Definition of intentional face-to-face interaction for med eval & management

DefinitionMedication Evaluation and Management is the intentional face-to-face interaction between a physician or nurse practitioner and a beneficiary for assessing the need for psychotropic medication, prescribing medications, and regular periodic monitoring for therapeutic effect and medical safety.

ProvidersPerformed by a physician or nurse practitioner as described in the service components for MAT.

PurposeUsed to assess need, prescribe, and monitor medications as part of MAT.