MedicaidCoverageMedium impact
Coverage of Buprenorphine Injection –REVISED May 13, 2020
Maryland Medicaid·MD · Psychiatry, Family Medicine, Internal Medicine·Provider Transmittal
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
Maryland Medicaid (MMCP) now covers buprenorphine extended-release injection (Sublocade®) for opioid use disorder treatment when medically necessary, effective July 1, 2019. Data 2000 waived practitioners can bill using HCPCS codes Q9991 and Q9992 with updated reimbursement rates effective January 1, 2020. This is a revised transmittal clarifying coverage and billing procedures for substance use disorder treatment.
Action Required
By June 30, 2020 (retroactive to July 1, 2019): Billing team must update billing system to recognize and process HCPCS codes Q9991 and Q9992 for Maryland Medicaid claims. Update fee schedules to reflect current rates (Q9991 and Q9992 both at $1,673.36 effective 1/1/2020). Ensure claims are submitted through Incedo Provider Portal, EDI 837 batch files, or U.S. Mail per Maryland PBHS Provider Billing Appendix. For dates of service on or after July 1, 2019, verify medical necessity documentation per MMCP Clinical Criteria before billing. Train providers and billing staff that these codes are only billable by Data 2000 waived practitioners. For preauthorization and billing questions, direct to Optum Maryland at marylandproviderrelations@optum.com or 1-800-888-1965.