MedicaidCoverageHigh impact
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
Effective January 1, 2025, Maryland Medicaid will begin covering buprenorphine extended-release injection (Brixadi) for opioid use disorder through the Behavioral Health Administrative Services Organization (BHASO). Eligible providers (OTPs, community-based SUD programs, and local health departments) must bill using new HCPCS codes J0577 and J0578 with specific reimbursement rates. The BHASO will not reimburse when medication is prescribed or obtained from pharmacy at point of sale.
Action Required
By December 31, 2024: Billing team must update billing system to recognize and process new HCPCS codes J0577 ($404.09 for ≤7 days therapy) and J0578 ($1,616.35 for >7 days therapy). Verify that your organization is one of the three eligible provider types (OTP-Provider Type 32, Community-based SUD Programs-Provider Type 50, or Local Health Department-Provider Type 35). Configure system to only process reimbursement when Brixadi is purchased from manufacturer and administered directly by provider—do NOT bill when medication is prescribed or obtained from pharmacy. Train billing staff on NDC codes 58284-208-01 through 58284-228-01 for proper claim submission. Contact Carelon at Provider.relations.MD@carelon.com with any billing questions. Claims submitted without proper configuration will be denied.