Opioid Treatment Programs (OTP)
OTP services are covered benefits for First Choice plan members.
OTPs provide evidence-based medication-assisted treatment (MAT) for members with opioid use disorder.
Select Health will adopt the guidelines as outlined in the SCDHHS Clinic Services Provider Manual, revised July 1, 2022.
Except for continuity of care purposes (90 days), coverage must be provided by providers who are contracted with Select Health and enrolled with SCDHHS. If a member has been treated by an out-of-network provider, we will work with providers and the member to transition to an in-network provider.
Prior authorization is not required by Select Health for OTP services rendered by participating providers. However, members must meet certain requirements to qualify for treatment and seek treatment from an in-network provider. Providers must also meet the service guidelines as outlined in the SCDHHS Clinic Services Provider Manual.
- Medical necessity must be confirmed at time of admission to the program by either a physician or advanced practice registered nurse (APRN), who is employed by or contracted with the OTP and must be documented in the member's medical record.
OTPs are reimbursed for all-inclusive procedure and assessment codes according to the SCDHHS fee schedule for the following services:
- Medication-Assisted Treatment Initial/Annual Assessment.
- Methadone Maintenance Treatment.
- Buprenorphine Maintenance Treatment.
Claims will be submitted directly to Select Health on a CMS 1500 claim form. Standard processing guidelines will apply.
For additional information or general questions, contact your Provider Network account executive or the Provider Contact Center at 1-800-575-0418.
Opioid Provider Resources