PDFWAC 182-531-2040
Enhanced reimbursement—Medication for opioid use disorder.
(1) The medicaid agency pays an enhanced reimbursement using the medicare rate when medication for opioid use disorder (MOUD) is part of the visit for selected evaluation and management (E/M) codes and the provider meets the criteria in this section.
(2) The purpose of this enhanced reimbursement is to increase client access to evidence-based treatment using medications for opioid use disorder.
(3) To receive the enhanced reimbursement for MOUD, a provider must:
(a) Bill using the agency's expedited prior authorization process;
(b) Bill for treating a client with a qualifying primary or secondary diagnosis for opioid use disorder;
(c) Ensure the client was offered, administered, or received a prescription for a federal Food and Drug Administration-approved medication for the treatment of opioid use disorder at the time the service was provided; and
(d) Provide opioid-related counseling during the visit.
(4) The agency payment for MOUD under this section is limited to one enhanced reimbursement, per client, per day.
(5) The agency does not pay an enhanced reimbursement for services a client receives for opioid use disorder through an opioid treatment program facility licensed by the department of health.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-07-078, s 182-531-2040, filed 3/17/25, effective 4/17/25; WSR 23-16-058, § 182-531-2040, filed 7/26/23, effective 8/26/23. Statutory Authority: RCW 41.05.021, 41.05.160, and 2018 c 299. WSR 19-09-052, § 182-531-2040, filed 4/12/19, effective 5/13/19.]