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Elizabeth M. Whitehorn, Director

Provider Notice Issued 03/19/2025

 

To: All Medical Assistance Program Providers
​Date March 19, 2025
​Re:
 Initiation of Buprenorphine - Medication for the Treatment of Opioid Use Disorder (MOUD) in the Hospital Emergency Department Setting 

Effective January 1, 2022, Public Act 102-0598 authorized coverage and reimbursement for the initiation (induction) of medication for the treatment of Opioid Use Disorder (MOUD) in a hospital emergency department (ED). This notice updates and provides additional guidance, superseding the previous guidance on Initiation of Medication Assisted Treatment (MAT) in a Hospital Emergency Department issued in the May 13, 2022, provider notice.    

Hospitals seeking reimbursement for initiation or induction of buprenorphine for the treatment of OUD in the emergency department (ED) setting must perform and document the following:

1)    An assessment to determine the individual has an OUD and appropriateness for Medication for Opioid Use Disorder (MOUD), a plan for initiating MOUD if appropriate, and patient education regarding MOUD, treatment services, and overdose prevention.

2)    Initiation of buprenorphine must occur in the emergency room and under appropriate medical supervision if the individual is in withdrawal or post-overdose. If the individual is not in withdrawal, a clinician may initiate buprenorphine via a home induction with a prescription at discharge. Medication management and prescribing must be in alignment with best practices and individuals should be prescribed MOUD until their follow-up appointment.  

3)    Referral for follow-up and ongoing care is a best practice for this service and should occur prior to discharge, consisting of a “warm handoff” to a community-based SUD treatment provider for follow up care or, when a “warm handoff” is not possible, connection to follow-up care should be arranged through the Medication Assisted Recovery (MAR NOW) program by contacting the Illinois Helpline for Opioids and Other Substances online or by calling 833-234-6343 and asking for an MAR NOW coordinator. 

Hospitals can bill for initiation of MOUD to HFS or the customer's HealthChoice Illinois managed care organization (MCO) using Procedure Code G2213 as an add-on to the primary procedure codes submitted on the 837I claim format. Reimbursement for G2213 will be made consistent with HFS EAPG pricing or MCO established reimbursement methodologies.

 

Code

Description

Service Time

G2213

Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure).

Event

 

Resources for initiating MOUD in the ER:

https://bridgetotreatment.org/
https://e.helplineil.org/mar-now/
https://helplineil.org/app/mar

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or to the applicable MCO.

 

Kelly Cunningham, Administrator
Division of Medical Programs