G2086 Off base opioid tx 70min

Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month

• Medicare coverage: Carrier judgment
• Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

• Practitioner: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction
• Outpatient hospital: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction

Medicare pricing for G2086

Physician Fee Schedule (CY 2026, RVU26D)

Status A: active, paid separately under the PFS if covered. National amounts: non-facility $491.33, facility $362.73 (total RVUs 14.71 / 10.86 × $33.4009 conversion factor). Work RVU 8.36, practice expense RVU 5.73 non-facility and 1.88 facility, malpractice RVU 0.62. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.