What do doctors typically charge for Office-based Treatment for Opioid Use Disorder?

The nationwide median physician charge for Office-based Treatment for Opioid Use Disorder (HCPCS G2086) is $450.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for HCPCS G2086?

The standard insurance baseline reimbursement rate is $363.19. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Office-based Treatment for Opioid Use Disorder

HCPCS G2086Medical Service

Office-based Treatment for Opioid Use Disorder

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. Clinical pricing breakdown and utilization metrics across 15 practicing doctors nationwide.

$450.00

Peer Median Charge

Gross billed rate

$363.19

Standard Baseline

Customary allowable

1.2x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT G2086?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $450.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $363.19 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code G2086 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"