Following its series of three white papers on the national opioid crisis, FAIR Health, a national, independent, nonprofit organization, studied how regions and states across the country differ in the medical procedures used to treat opioid abuse and dependence. Drawing on its database of billions of privately billed healthcare claims, FAIR Health analyzed, for the recent year 2017, the top 10 procedure codes associated with opioid abuse and dependence diagnoses by utilization and aggregate cost in each US census region (Northeast, Midwest, South, West); five types of such opioid-related codes by state (behavioral health, medication-assisted treatment, inpatient treatment, outpatient rehabilitative services, emergency department visits); and the top five opioid-related codes by utilization and cost in each state. The study revealed considerable variation across regions and states: (1) Group psychotherapy (CPT(R) 90853) and methadone administration (H0020) were common throughout much of the country. But, methadone administration was particularly associated with the Northeast, while another medication, naltrexone injection (J2315), was more closely associated with the Midwest. (a) Group psychotherapy was one of the 10 most common procedures by utilization in every region except the South. (b) Methadone administration was among the 10 most common procedures by utilization in every region, and among the top 10 by cost in one region, the Northeast. (c) Naltrexone injection was in the top 10 list by cost in only one region, the Midwest. (2) Outpatient rehabilitative services were linked more to the South and West than to other regions.(3) The South relied more on testing than on therapeutic procedures, while the West had a strong emphasis on treatment. (4) Two inpatient treatments, sub-acute detoxification (H0010) and short-term residential (H0018), were included in the list of top 10 procedures by cost in one region, the West. (5) Emergency department (ED) visits were found in the top 10 lists by cost only in the Northeast and Midwest. (6) Among the 50 states and the District of Columbia: (a) Only New York had group counseling (H0005) as one of its five most common procedures by utilization and cost. (b) Only California had intensive outpatient treatment (H0015) in its top five list by utilization. (c) Sub-acute detoxification (H0010) appeared in the top five lists of only two states, Mississippi and Tennessee, and there only by cost. (d) Only five states--Delaware, Nebraska, North Dakota, South Dakota and Wisconsin--included psychotherapy, 45 minutes (CPT 90834), as one of their five most common procedures by utilization. (e) Only Wyoming included among its top five procedures by cost an ED visit, high severity, immediate significant threat to life or physiologic function (CPT 99285). (7) The variations in the dominant procedures offer opportunities to investigate what kinds of outcomes are associated with the various treatment strategies.
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