MedicaidCoverageHigh impact
Updated Coverage of Brixadi for Opioid Use Disorders
Maryland Medicaid·MD · Psychiatry·Behavioral Health Administration Services Organization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now covers Brixadi (buprenorphine extended-release injection) for opioid use disorder effective January 1, 2025, through the Behavioral Health Administrative Services Organization (BHASO). Eligible providers (OTP, community-based SUD programs, and local health departments) must bill using new HCPCS codes J0577 and J0578 at specified rates. The policy supersedes PT 56-25 and explicitly prohibits reimbursement when medication is prescribed or obtained from pharmacy.
Action Required
By January 1, 2025: Billing team at eligible Maryland providers (OTP, community-based SUD programs, local health departments) must update billing systems to add HCPCS codes J0577 ($428.66 for ≤7 days therapy) and J0578 ($1,714.63 for >7 days therapy) for Brixadi administration. Configure system to bill only when Brixadi is purchased directly from manufacturer and administered on-site—block claims when medication is prescribed or obtained from pharmacy point-of-sale. Train clinical and billing staff on NDC codes (58284-208-01 through 58284-228-01) and billing restrictions. Contact Carelon at Provider.relations.MD@carelon.com for technical billing questions. Failure to implement correctly will result in claim denials.