Payment for Substance Abuse Screening and Brief Intervention
Screening and Brief Intervention (SBI) is a proven method to identify, and intervene with, individuals who are at risk for alcohol-related problems or injuries. The goal of SBI is to use systems such as physician offices, trauma centers/emergency rooms, community clinics, and school clinics to screen patients for at-risk alcohol or other substance use and, if necessary, provide them with a brief intervention or referral to appropriate treatment. By screening people in these settings, those who have a substance use-related illness or injury can be identified and motivated to engage in treatment.
Recently the American Medical Association approved new CPT (Current Procedural Terminology) codes to reimburse physicians for services to identify and treat patients with alcohol and drugs problems. In addition, the federal Centers for Medicare and Medicaid Services (CMS) implemented policies to reimburse physicians for services to identify and treat Medicare and Medicaid patients’ problems with alcohol and other drugs. Specifically, CMS instructed its fiscal intermediaries to pay on two new Health Care Procedure Code Set (HCPCS) G codes for reporting SBI services for Medicare fee-for-service schedule (FFS) and two new HCPCS H codes that Medicaid and other insurers can use to process medical insurance claims for SBI services.
The new screening and brief intervention codes will help expand the treatment of substance use disorders to primary medical providers. Making the identification and treatment of substance use disorders the business of family doctors will help to increase the number of people getting treatment.
Our SBI Reimbursement Guide will provide you with everything you need to know to conduct SBI and get paid for it. This guide provides information for how billing codes can be used to ensure that screening and brief intervention services are reimbursed in a variety of settings.
Below is a table that shows the specific SBI codes and associated fee schedules for commercial insurance, Medicare, and Medicaid.
|Commercial Insurance||CPT 99408||Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes||$33.41|
|CPT 99409||Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes||$65.51|
|Medicare||G0396||Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes||$29.42|
|G0397||Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes||$57.69|
|Medicaid||H0049||Alcohol and/or drug screening||$24.00|
|H0050||Alcohol and/or drug service, brief intervention, per 15 minutes||$48.00|