Configure Roll-Up Services Definition - PM

The Roll-Up Services Definition form allows agencies to bill OTP services efficiently. This section will explain how to setup a drug bundle for a drug that was administered in-clinic (e.g. G2067 for a methadone bundle).

Weekly Drug Bundles

Each weekly drug bundle will need to be created as a roll-up service definition. In the example below, we will walk through how to set up a roll-up services definition for the methadone in-clinic drug bundle (G2067).

Component Services – Select all service codes that can be a part of the weekly bundle. For a methadone in-clinic drug bundle (G2067), this can include methadone in-clinic doses, additional methadone take-home doses, substance use counseling, individual and group therapy, and toxicology testing.

Required Component Service(s) for Roll-Up to Occur – This field is populated with the component service(s) selected in the previous field. Check off the service code that corresponds to the drug. In this case, we have service code M070 selected.

Component Service Date Rule – Select ‘Same Week (7 Days)’

Start Day of the Week – Select the appropriate start day of the week for your organization. Some organizations will start their weekly bundles on Sundays while others start them on Monday. CMS states, “OTPs may choose to apply a standard billing cycle by setting a particular day of the week to begin all episodes of care”, so this gives organizations flexibility in determining when their week will start. Other payors might have different guidelines, so please consult with your payor(s) to confirm the requirements.

Date of Service for Roll-Up Service – Select ‘First Day of the Week’. CMS states, “OTPs may choose to apply a standard billing cycle by setting a particular day of the week to begin all episodes of care. In this case, the date of service would be the first day of the OTP’s billing cycle. If a beneficiary starts treatment at the OTP in the middle of the OTP’s standard weekly billing cycle, the OTP may still bill the applicable code for that episode of care provided that it meets the threshold to bill for the code.”

Is This Roll-Up Service Dependent on Units, Duration, or None – Set this to ‘None’

Calculate Fixed Fee Charge By – Set this to ‘None’

Weekly Non-Drug Bundles

Depending on the client’s MAT regimen, there might be non-drug weeks. Those weeks are billed as a weekly bundle with code G2074 via a roll-up. When the roll-ups are executed later, it is critical that the non-drug roll-up occur after the drug roll-ups.

Component Services – Select all service codes that can be a part of the weekly bundle. In the example of G2074, this would include all other applicable services with the exclusion of drug doses (in-clinic and take-home).

            Component Service Date Rule – Select ‘Same Week (7 Days)’

Start Day of the Week – Select the appropriate start day of the week for your organization. Some organizations will start their weekly bundles on Sundays while others start them on Monday. CMS states, “OTPs may choose to apply a standard billing cycle by setting a particular day of the week to begin all episodes of care”, so this gives organizations flexibility in determining when their week will start. Other payors might have different guidelines, so please consult with your payor(s) to confirm the requirements.

Date of Service for Roll-Up Service – Select ‘First Day of the Week’. CMS states, “OTPs may choose to apply a standard billing cycle by setting a particular day of the week to begin all episodes of care. In this case, the date of service would be the first day of the OTP’s billing cycle. If a beneficiary starts treatment at the OTP in the middle of the OTP’s standard weekly billing cycle, the OTP may still bill the applicable code for that episode of care provided that it meets the threshold to bill for the code.”

Is This Roll-Up Service Dependent on Units, Duration, or None – Set this to ‘None’

Calculate Fixed Fee Charge By – Set this to ‘None’