AdministrativeCommercialOctober 31, 2023

NY 2022 AB372 - Prohibits Copayments for Opioid Treatment Programs

Billing with the “HG” HCPCS modifier

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Under NY 2022 AB372 - Prohibits Copayments for Opioid Treatment Programs, plans are prohibited from imposing copayments and/or coinsurance during treatment through an in-network opioid addiction outpatient treatment program. The deductible applies for all plans. Once the deductible is met, coinsurance is waived. Outpatient professional and outpatient facility services are in scope for the cost share waiver. Inpatient services are out of scope for this mandate.

To better identify these types of claims, we are asking you to begin billing with the HCPCS modifier “HG” for services provided through an opioid addiction treatment program on an outpatient professional and/or outpatient facility basis. By billing with the modifier “HG,” you will help ensure members are paying the appropriate cost share per the mandated requirements.

Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Medicaid products offered by Empire BlueCross BlueShield HealthPlus, which is the trade name of HealthPlus HP, LLC. Independent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

NYBCBS-CM-040422-23

PUBLICATIONS: November 2023 Provider Newsletter