SBIRT

　

Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an evidence-based practice designed to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model calls for community-based screening for health risk behaviors. SBIRT offers an opportunity to identify problem drinking and substance abuse, and trigger intervention.

This fact sheet provides health care professionals with an overview of Medicare and Medicaid coverage of SBIRT services, including who may perform the services, documentation requirements, billing and coding guidance, payment information, and resources for additional information.

SBIRT consists of three major components:  

1. Structured Assessment (Medicare) or Screening (Medicaid): Assessing or screening a patient for risky substance use behaviors using standardized assessment or screening tools;
2. Brief Intervention: Engaging a patient showing risky substance use behaviors in a short conversation, providing feedback and advice; and
3. Referral to Treatment: Providing a referral to brief therapy or additional treatment to patients whose assessment or screening shows a need for additional services.

SBIRT Under Medicare Who May Provide SBIRT Services?
 Medicare pays for medically reasonable and necessary SBIRT services when you furnish them in physicians’ offices and outpatient hospitals. In these settings, you assess for and identify individuals with, or at-risk for, substance use-related problems and furnish limited interventions/treatment.

To bill Medicare overall, suppliers of SBIRT services must be:

 Licensed or certified to perform mental health services by the State in which they perform the services;


Qualified to perform the specific mental health services rendered; and  Working within their State Scope of Practice Act.  In addition to the three requirements listed above, Table 1 provides more information on the specific qualifications for suppliers authorized under Medicare to furnish SBIRT services.

SBIRT Assessment and Screening Tools

 The first component to the SBIRT process is screening. Screening tools include the World Health Organization’s Alcohol Use Disorders Identification Test (AUDIT) Manual and the Drug Abuse Screening Test (DAST).


Health Care Suppliers Eligible to Provide SBIRT Services

Physician
Physician Assistant : PA-C
Nurse Practitioner - NP
Clinical Psychologist - CP
Clinical Nurse Specialist - CNS
Certified Nurse Midwife - CNM


How Must I Document SBIRT Services?
 

Information in the patient’s medical record must support all claims for Medicare services. The medical record for covered SBIRT services must:

Create complete, legible medical records;

Denote start/stop time or total face-to-face time with the patient (because some SBIRT Healthcare Common Procedure Coding System [HCPCS] codes are time-based codes);

Document the patient’s progress, response to changes in treatment, and revision of diagnosis;

Document the rationale for ordering diagnostic and other ancillary services, or ensure that it can be easily inferred;

For each patient encounter, document: Assessment, clinical impression, and diagnosis;

Date and legible identity of observer/provider;
 Physical examination findings and prior diagnostic test results;
 Plan of care; and

Reason for encounter and relevant history;

Identify appropriate health risk factors;
 Include documentation to support all Current Procedural Terminology (CPT) and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes reported on the health insurance claim; ( PENDING ICD-10 )


How Must I Bill and Code SBIRT Services?
Medicare
 


HCPCS Code G0396  




Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST), and brief intervention 15 to 30 minutes
 HCPCS Code G0397
 Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST), and intervention, greater than 30 minutes