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SBIRT Payment Update

Date:
June 21, 2019

We began reimbursing for Screening, Brief Intervention, and Referral to Treatment (SBIRT) in February 2018. Since that time, Medicare has added a new SBIRT code for reimbursement:

  • G2011 – Alcohol and/or substance abuse assessment, 5 to 15 minutes

SBIRT, an evidence-based approach to early identification of patients at risk for substance abuse, is reimbursed as follows:

Commercial:

SBIRT is covered as a preventive benefit without cost-share when billed alone or in conjunction with another service; if a plan is grandfathered without preventive service benefits, a cost-share will be applied. Codes for reimbursement are:

  • 99408 – Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes
  • 99409 – Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST) and brief intervention, longer than 30 minutes

Medicare Advantage:

SBIRT will be covered, but per Medicare contract language, we cannot remove patient cost-share even if it is billed in conjunction with a preventive service. In addition to G2011, codes for reimbursement are:

  • G0396 – Alcohol and/or substance (other than tobacco) abuse with structured assessment (AUDIT, DAST) and brief intervention, 15 to 30 minutes
  • G0397 – Alcohol and/or substance (other than tobacco) abuse with structured assessment (AUDIT, DAST) and brief intervention, longer than 30 minutes

Physicians, physician assistants, nurse practitioners, certified nurse-midwives, clinical psychologists and licensed clinical social workers (LCSW) are all eligible to provide reimbursable SBIRT services, but must have completed the four-hour training conducted by the Office of Alcoholism and Substance Abuse Services (OASAS). Please go to oasas.ny.gov for more information about SBIRT and OASAS training.

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