HCPCS Code G2213: Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) has become a critical tool in addressing the opioid crisis, particularly in emergency departments (EDs). One key code every hospital and coding professional should understand is HCPCS Level II code G2213.

This article explains what G2213 is, when it should be reported, documentation best practices, and common compliance considerations.

What Is Medication-Assisted Treatment (MAT)?

Medication-assisted treatment—also referred to as medications for opioid use disorder (MOUD)—combines FDA-approved medications with clinical assessment, patient education, and follow-up planning to treat opioid use disorder (OUD).

In the ED, MAT often involves initiating buprenorphine or buprenorphine/naloxone for patients presenting with overdose, withdrawal, or other complications related to opioid use. The goal is to stabilize the patient and connect them to ongoing treatment after discharge.

What Is HCPCS Code G2213?

HCPCS code G2213 was introduced by Medicare to recognize the additional work involved in starting MAT in the emergency department.

Code description:
Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (reported separately in addition to the primary procedure).

Key Coding Facts

Add-on code (cannot be billed alone)
Reported with ED E/M codes 99282–99285
Reflects the extra time and resources required for MAT and care coordination

What Services Does G2213 Include?

G2213 is intended to cover activities that go beyond the standard ED evaluation and management service, including:

Assessment for opioid use disorder and MOUD appropriateness
Patient education on treatment options and overdose prevention
Initiation or induction of MAT in the ED
Prescription planning when home induction is appropriate
Referral and coordination of follow-up care
Arranging access to supportive or community-based services

These services must be clearly documented to support billing.

When Should G2213 Be Reported?

G2213 may be billed when:

A patient receives initiation of MAT in the ED
The service is performed in conjunction with an ED E/M visit
Assessment, treatment initiation, and follow-up planning are documented

It should not be reported if MAT is discussed but not initiated, or if no referral or follow-up planning occurs.

Documentation Best Practices for G2213

Although Medicare has not published detailed documentation rules for G2213, auditors generally expect clear evidence of the work performed.

Strong documentation should include:

Clinical assessment supporting an OUD diagnosis
Decision-making regarding MAT initiation
Medication details, including dosing or discharge prescription
Patient education related to treatment and safety
Referral or follow-up arrangements made prior to discharge

Clear, concise documentation helps reduce audit risk and supports medical necessity.

Diagnosis Coding Considerations

When reporting G2213, the primary diagnosis should reflect opioid use disorder. Diagnosis codes are typically selected from ICD-10-CM category F11 (opioid-related disorders).

Accurate diagnosis coding is essential to demonstrate the medical necessity of MAT services.

Compliance Tips for Hospitals and ED Providers

To ensure proper use of G2213:

Educate ED clinicians on when MAT qualifies for separate reporting
Standardize MAT documentation templates in the EHR
Verify that G2213 is billed only as an add-on to ED E/M codes
Conduct periodic internal audits for consistency and compliance

Why G2213 Matters

By recognizing the additional work involved in MAT initiation, G2213 supports emergency departments in expanding access to evidence-based treatment for opioid use disorder. Proper coding not only ensures reimbursement but also reinforces the importance of early intervention and continuity of care.

Final Thoughts

As MAT continues to play a vital role in emergency medicine, understanding HCPCS code G2213 is essential for coders, compliance teams, and revenue cycle leaders. With accurate documentation and correct coding, hospitals can support patient care while maintaining Medicare compliance.

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