Overview of Medicare Coverage

Buprenorphine treatment costs are typically not covered by Medicare unless the treatment is provided in an inpatient or outpatient treatment center. It may also be covered in some instances, such as during detoxification or early stage stabilization. However, the Medicare benefit does not usually cover typical office-based buprenorphine induction or maintenance treatment visits.

In some instances, Medicare Part D may cover the cost of the buprenorphine tablets themselves. Only some Medicare providers will reimburse (including Healthnet Orange, Silverscript, and Wellcare) and prior authorization is usually required.

Learn more about Medicare coverage for buprenorphine treatment by searching the online Formulary Finder for Prescription Drug Plans and Advantage Prescription Drug Plans. Note: search under "Suboxone®" in these guides.



Related Resources: 
Description: 
Displays the appropriate CPT and HCPCS billing codes for the different phases of buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is a database that allows users to search Medicare Prescription Coverage and Medicare Advantage Prescription Drug Plans by State.
Source: 
Department of Health and Human Services
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Description: 
This database allows physicians to search for local Medicare policies and relevant articles.
Source: 
US Department of Health and Human Services
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Description: 
This is the web format of a special addiction program by HBO. The material covers issues such as who pays for addiction treatment, and drug treatment for adolescents.
Source: 
Home Box Office, Inc., 2007
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