Table 3.

Input Data and Descriptive Details for Payment by Insurance Type42-44

Visit TypeMedicare $ (SD)Medicaid $ (SD)Private $ (SD)Uninsured/Self-Pay $ (SD)
Initial medical evaluation (99204/G0466a)158.80 (22.80)106.60 (31.40)222.70 (2.40)106.60 (31.40)
Follow-up medical evaluation, Level 3 (99213/G0467)68.00 (13.80)45.50 (12.70)111.10 (0.90)45.50 (12.70)
Follow-up medical evaluation, Level 4 (99214/G0467)101.70 (18.20)68.60 (21.20)156.70 (1.20)68.60 (21.20)
Follow-up nursing visit (99211)17.40 (7.60)10.80 (6.20)46.80 (1.80)10.80 (6.20)
Behavioral health intake assessment (90791/G0469)142.60 (11.70)73.10 (6.00)126.40 (2.70)73.10 (6.00)
Group psychotherapy (90853), 12 patients per group28.00 (2.20)14.40 (1.10)151.90 (21.30)14.40 (1.10)
Urine drug screen (80305/G0477)13.50 (2.80)11.90 (2.50)55.00 (27.30)11.90 (2.50)
  • OBOT-B = office-based opioid treatment with buprenorphine.

  • Note: For insurance rates, we sampled from the probability distribution of Medicare payer prevalence. If a simulated individual was not selected to have Medicare, we sampled from the Medicaid prevalence. If the simulated individual was not selected to have Medicaid, we sampled from the private insurance prevalence. If the individual was not selected to have private insurance, they were assigned as self-pay/uninsured. Payment rates were log-transformed before sampling to adjust for skew and were determined from the Medicare Physician Fee Schedule Look-up Tool, publicly available state Medicaid fee schedules, and the Collective Health database of commercial payment rates.42-44 Appropriate billing codes for OBOT-B were determined in consultation with interviewed primary care practice representatives and informed by guidance from the Centers for Medicare & Medicaid Services, Substance Abuse and Mental Health Services Administration, and National Association of Community Health Centers.36-38

  • a Current Procedural Terminology (CPT) visit codes.