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SBIRT (Screening, Brief Intervention, Referral and Treatment)

NEW YORK STATE OFFICE OF ALCOHOLISM AND SUBTANCE ABUSE SERVICES
Addition Services for Prevention, Treatment, Recovery

Addiction Medicine FYI

SBIRT (Screening, Brief Intervention, Referral and Treatment)

What is SBIRT?

Screening. With just a few questions on a questionnaire or in an interview, practitioners can identify patients who have alcohol or other drug (substance) use problems and determine how severe those problems already are.  Three of the most widely used screening tools are the Alcohol Use Disorders Identification Test (AUDIT), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and the Drug Abuse Screening Test (DAST).

Brief Intervention. If screening results indicate at risk behavior, individuals receive brief interventions. The intervention educates them about their substance use, alerts them to possible consequences and motivates them to change their behavior.

Brief Treatment. If individuals are at moderate to high risk, the next step is brief treatment. Similar to brief intervention, this emphasizes motivations to change and client empowerment, though it consists of a limited number of highly focused and structured clinical sessions with the purpose of eliminating hazardous and/or harmful alcohol and/or other substance use.

Referral to Treatment. Individuals whose screening indicates a severe problem or dependence should be referred to an OASAS-certified specialty care provider for treatment of a substance use disorder (SUD).

Why use SBIRT?

SBIRT has been proven highly effective in motivating those whose substance use is unhealthy to alter their use. The Screening, Brief Intervention, Referral and Treatment (SBIRT) programs that are funded through the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) have shown that, of everyone screened, 20 percent are positive for risky, problematic substance use.

Of that 20 percent, 70 percent can be treated by a single brief intervention; 15 percent need six or fewer follow-up interventions; and 15 percent have dependence and need specialty care for SUDs. Preliminary SBIRT data show a total of 74 percent of high-risk individuals reported lowering their drug or alcohol consumption after one or more brief treatment sessions and 48 percent reported stopping use. Making behavioral health screening part of primary care makes sense and, by taking this public health approach to substance abuse, we can lower health care costs because we’re reaching individuals before they need specialized treatment.

Are there codes that can be used for reimbursement?

In January 2008, the American Medical Association (AMA) introduced new health care codes for screening and brief intervention (SBI).  Fees are based on length of activity (15 -30 minutes; more than 30 minutes):

Code Description
CPT 99408 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
H0049 Alcohol and/or drug screening
H0050 Alcohol and/or drug service, brief intervention, per 15 minutes

The G-codes, which may only be used for people age 65 and older, use the definitions under the Healthcare Common Procedure Coding System (HCPCS) and focus on "assessment" instead of "screening." G0396 is defined as: "Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, ASSIST, DAST) and brief intervention, 15-30 minutes." G0397 is defined as:  "Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and intervention, greater than 30 minutes." (Note that Medicare calls the 15-30 minute intervention "brief," but does not use that same denomination for the longer intervention.)  

Healthcare professionals may also use the Healthcare Common Procedure Coding System (CPT) codes (99408 and 99409) and Medicare made it much easier for them to do so by publishing the RVUs (relative value units) for the CPT codes. These RVUs, when multiplied by the conversion factor, give the dollar amount payable per code. Since most payers rely on the Medicare fee schedule, at least as a jumping off point to set their own fees, the publishing of RVUs makes it much more likely that non-Medicare patients will get these services as well.  Finally, billing codes H0049 and H0050 are also available to practitioners who have provided SBI services.

With specific reference to Medicaid reimbursement for these services, each State must adopt or “turn on” the codes as part of its approved plan for services. As of January 2010, New York has activated these codes for use with Medicaid patients who are seen in a primary care clinic or emergency department.  Payment in these settings is calculated as part of the established ambulatory payment group (APG) methodology.  SBI reimbursement is further authorized, in New York, for services provided by federally qualified health centers that have agreed to the APG reimbursement methodology for their clinic services.  For additional information on APGs, please refer to the New York State Department of Health’s website, Ambulatory Care Payment Reform - Ambulatory Patient Groups (APGs).

For more information:

Updated 2/10