HCPCS Q9991 is officially defined as "Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg." HCPCS Q9991 is referenced in 7 tracked payer policy changes from CareSource, Maryland Medicaid, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q9991 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
CareSource Georgia Medicaid is implementing new prior authorization requirements effective April 1, 2026, for 57 specific billing codes across multiple service categories including genetic testing, durable medical equipment, orthotic/prosthetic devices, and surgical procedures. All non-participating providers and inpatient services already require prior auth; this update expands requirements to include these specific codes for all providers.
Maryland Medicaid expanded coverage for long-acting injectable buprenorphine (Brixadi, Sublocade, Vivitrol) to include Physicians, Nurse Practitioners, and Physician Assistants, effective March 1, 2026. Reimbursement rates have been updated for all three medications, and providers must have current DEA registration to bill. BHASO will only reimburse when drugs are purchased from manufacturer and administered directly by the provider—not when prescribed only or obtained from pharmacy.
Florida Blue updated reimbursement for about 60 physician-administered drug codes in its Physician-Administered Drug Program, administered by Prime Therapeutics Management Medical Pharmacy Solutions, effective October 1, 2026. That date has already passed as of November 4, 2026, so the new rates should already be in use for the affected Florida Blue HMO, PPO, State Employees PPO and Truli for Health claims, and the practice should confirm its drug fee schedule reflects them.
Oregon Health Authority has adjusted reimbursement rates for six behavioral health/substance use disorder injection codes effective April 1, 2026. Most rates decreased slightly (buprenorphine codes down $5.62–$22.47), while Sublocade and naltrexone rates increased minimally ($0.01–$20.01). Billing teams must update fee schedules in their systems by July 1, 2026 when OHA publishes the revised Behavioral Health Fee Schedule.
Maryland Medicaid expanded coverage of long-acting injectable buprenorphine (Brixadi and Sublocade) to include nurse practitioners and physician assistants, and updated reimbursement rates for these substance use disorder treatments. Providers must purchase drugs directly from manufacturer and have current DEA registration to bill these codes.
Oregon Medicaid updated fee schedule rates for substance use disorder injection codes Q9991 and Q9992 (buprenorphine extended-release/Sublocade) to $1,976.55 per service. This rate increase was effective July 1, 2025, and providers should continue billing normally as the updated rates are already active in the system.
Aetna considers Sublocade, the once-monthly buprenorphine injection, medically necessary for moderate-to-severe opioid use disorder in members who started treatment with a transmucosal buprenorphine product and have been on a stable dose for a minimum of seven days, when it is used as part of a complete treatment program that includes drug testing, counseling and psychosocial support. Brixadi, a buprenorphine extended-release subcutaneous injection, is covered for moderate-to-severe opioid use disorder in individuals who started treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine. Aetna considers the buprenorphine implant and the once-monthly injectable experimental and investigational for all other indications.
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