Notice to providers who provide Suboxone counseling in their offices:

Please report these services by using diagnosis codes 304.0 or 304.7 and evaluation and management codes 99201-99215 or 99241-99245.

PCPs: When these services are provided to members on your panel, they are covered under your monthly capitation. Because it may be difficult for our members to access these services, if a PCP should render these services to members who are not on their panel, a referral is required from the member’s PCP and then the rendering PCP will be reimbursed on a FFS basis.

Specialists will be reimbursed their contracted rates for these services. A referral from the member’s PCP is required.

As a reminder, payment from Gateway Health Plan^® is considered payment in full and providers are not permitted to bill our members for any covered services.