SBIRT Basics - From Medicare and MaineCare

SBIRT is an early intervention approach that targets individuals with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment. This approach differs from the primary focus of specialized treatment of individuals with more severe substance use, or those who have met the criteria for diagnosis of a Substance Use Disorder.

S - Screening: Assessing a patient for risky substance use behaviors using standardized screening tools;

BI - Brief Intervention: Engaging a patient showing risky substance use behaviors in a short conversation, providing feedback and advice; and

RT - Referral to Treatment: Providing a referral to brief therapy or additional treatment to patients who screen in need of additional services.

What Types of Health Care Providers May Provide SBIRT Services Under Medicare

Health Care Providers Eligible to Provide SBIRT Services

•Physician

  • NP/PA
  • CNS
  • Clinical Psychologist
  • Clinical Social Worker (LCSW)

How Must I Document SBIRT Services?

Documentation of each patient encounter should include: o

•Reason for encounter and relevant history,

•Physical examination findings and prior diagnostic test results, (as appropriate by provider)

•Assessment, clinical impression, and diagnosis,

•Plan for care,

•Date and legible identity of observer;

•Start/stop time or total face-to-face time with the patient, because the SBIRT G-codes are time-based codes;

•Appropriate health risk factors should be identified;

•The patient’s progress, response to changes in treatment, and revision of diagnosis should be documented; and

•The CPT and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes reported on the health insurance claim should be supported by documentation in the medical record.

In addition:

•If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred;

•Past and present diagnoses should be accessible for the treating and/or consulting physician;

How Will Medicare Pay for SBIRT Services?

HCPCS Code / Descriptor
G0396 / Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes
G0397 / Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and intervention, greater than 30 minutes
Medicare Contractors will consider payment for HCPCS codes G0396 and G0397 only when medically reasonable, and necessary (i.e., when the service is provided to evaluate and/or treat patients with signs/symptoms of illness or injury)…

What Screening Tools should I use?

CMSdoes not identify specific alcohol misuse screening tools. Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting. Various screening tools are available for screening for alcohol misuse.

How should I structure the SBIRT session?

The 5A’s approach has been adopted by the USPSTF. They are:

  1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral for intensive or specialized services

References:

Medical Learning Network.Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse ICN May 2012

MLN Matters: “Summary of Medicare Reporting and Payment of Services for Alcohol and /or Substance (Other than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services . Updated August 27, 2012

MaineCare Provider Information for SBIRT

Effective 1/01/2013, physician’s offices enrolled under MaineCare Benefits Manual, Chapter II- Section 90 should use the following SBIRT codes:

  • 99408-Alcohol and/or substance (other than tobacco) abuse structured screening (eg. Audit, DAST), and brief intervention (SBI) services; 15 to 30 minutes (Note: this code replaces G0396)
  • 99409- Alcohol and/or substance (other than tobacco) abuse structured screening (eg. Audit, DAST), and brief intervention (SBI) services; greater than 30 minutes (Note: this code replaces G0397)

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Reimbursement for SBIRT

The American Medical Association (AMA) has approved several billing codes that will allow you to be reimbursed for providing screening and brief intervention services. Medical procedures are coded using Common Procedure and Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Screening and brief intervention may be provided in an office, emergency department or inpatient visit for both new and established patients. Virtually all payers use AMA’s Evaluation and Management (E & M) CPT codes to pay physicians' services. Many payers reimburse for independent licensed health practitioners such as advance practice nurses, psychologists, and masters-level social workers. A few will pay for service provided by health professionals under the supervision of a physician.

Payer / Code / Description / Fee Schedule
Commercial Insurance, Medicaid / 99408 / Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30min / $33.41
Commercial Insurance, Medicaid / 99409 / Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30min / $65.51
Medicare / G0396 / Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30min / $29.42
Medicare / G0397 / Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30min / $57.69
Medicare / G0442 / Prevention: Screening for alcohol misuse in adults including pregnant women once per year. No coinsurance; no deductible for patient / $17.33
Medicare / G0443 / Prevention: Up to four, 15 minute, brief face-to-face behavioral counseling interventions per year for individuals, including pregnant women, who screen positive for alcohol misuse; No coinsurance; no deductible for patient / $25.14
Medicaid / 99408 / Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30min / $21.04
Medicaid / 99409 / Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30min / $40.18

SAMHSA-HRSA Center for Integrated Health Solutions

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