Medicaid B: Opioid Maintenance Therapy (OMT)

• Clinical Coverage Policy 8A-9

Submission Requirements

Initial:

• No Prior Authorization is Required
• Provider maintains copy of service plan in the record

Concurrent:

• No Prior Authorization is Required
• Provider maintains copy of service plan in the record

Service Definition Authorization Parameters

No authorization required

ASAM Level of Care

OMT or other as indicated