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Updates to Reimbursement Rates and Coverage for Long-Acting Injectable Buprenorphine for Substance Use Disorders
Act
by Mar 1, 2026
Effective date
Mar 1, 2026
Identified
Sep 29, 2026
Summary
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.
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What to do
by Mar 1, 2026 · 5 steps
01Billing team must update billing software to reflect new reimbursement rates for Brixadi (J0577: $420.05; J0578: $1,680.21), Sublocade (Q9991/Q9992: $1,998.53 each), and Vivitrol (J2315: $4.24/unit).
02Providers must verify current DEA registration is submitted in ePREP before submitting claims for these codes.
03Billing staff must configure system to only allow reimbursement when drugs are purchased from manufacturer and administered directly to patient—reject claims for prescription-only or pharmacy-obtained medications.
04Update internal workflows to clarify billing eligibility is limited to Physicians (Type 20), Nurse Practitioners (Type 23), and Physician Assistants (Type 80).
05Contact Carelon at 1-800-888-1965 for billing questions.
If missed: Failure to comply will result in claim denials for ineligible providers or improper billing scenarios.
Codes mentioned
J0577J0578Q9991Q9992J2315
Original notice
Updates to Reimbursement Rates and Coverage for Long-Acting Injectable Buprenorphine for Substance Use Disorders
health.maryland.gov · Always check the source before changing claims.
Related changes
See all Maryland Medicaid changes →PT 75-26: Updates to Reimbursement Rates and Coverage for Long-Acting Injectable Buprenorphine for Substance Use DisordersMediumEffective Mar 1, 2026 · Claims & BillingCoverage of Buprenorphine Injection –REVISED May 13, 2020MediumEffective Jul 1, 2019 · Provider TransmittalCoverage of Brixadi for Opioid Use DisordersHighEffective Jan 1, 2025 · Behavioral Health Administration Services OrganizationUpdated Coverage of Brixadi for Opioid Use DisordersHighEffective Jan 1, 2025 · Behavioral Health Administration Services OrganizationBrowse every Maryland Medicaid change in the policy list