Retroactive Rate Update: Section 65, Opioid Treatment Program (OTP) Services, CR 136636

Dec 29, 2025

MaineCare updated the OTP (H0020) rate retroactively due to a rate update from the Centers for Medicare Services (CMS) in March 2025. This new rate was implemented for billing on December 17, 2025.

The new rate is effective January 1, 2025, and reflects 72.4% of the Medicare rate. An updated fee schedule is available on the rate setting page of the Health PAS Online Portal.

Adjustment Billing Guidance for Dates of Service January 1, 2025, Through December 16, 2025

• Providers must adjust all claims that were billed and paid with charges below the new rates within one year of the original payment date. To avoid timely filing denials, please adjust the oldest dates of service first. 
• MaineCare will adjust claims that were billed and paid at or above the new rates.  

For questions, please contact your Provider Relations Specialist.