by Wyn Staheli, Director of Content - innoviHealth
Nov 17th, 2014 - Reviewed/Updated Apr 30th
Medicare understands that there are individuals who may not meet the diagnostic criteria for substance abuse but who are still at risk. To help identify these individuals and take steps to keep them from reaching the level of abuse, Medicare has established a program called the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services.
For Medicares Fact Sheet (ICN 904084) regarding this program, review the “Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services.” This fact sheet is designed to provide education on documentation, billing, treatment programs, and fee schedules for screening, brief intervention, and referral to treatment services. It includes an early intervention approach that targets those with non-dependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.
These early intervention services are not just for behavioral health providers. Rather, they are intended to be utilized by the following types of healthcare providers:
- Physicians
- Physician Assistants
- Nurse Practitioners
- Clinical Nurse Specialists
- Clinical Psychologists
- Clinical Social Workers
- Certified Nurse Midwives
G0397 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
G2011 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
G2087 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month
G2088 Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)
G1028 Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G2215 Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G2216 Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
Note: Payment limit for HCPCS codes G1028, G2215, and G2216 is once every 30 days unless an additional take-home supply of the medication is medically reasonable and necessary.
Billing Medicaid SBIRT Services
G0397 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
G0442 Annual alcohol misuse screening, 5 to 15 minutes
G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
G0444 Annual depression screening, 5 to 15 minutes
H0049 Alcohol and/or drug screening
H0050 Alcohol and/or drug services, brief intervention, per 15 minutes
References/Resources
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.