Reimbursement for SBIRT Services

SBIRT services are covered by Medicaid, Medicare, and most commercial insurance plans.
The Maryland SBIRT Policy Steering Committee is developing strategies for expanding reimbursement options for SBIRT services provided by healthcare professionals other than primary care providers.

The Maryland SBIRT Project helps providers set up procedures for billing for SBIRT services.  The Project encourages all providers to code for SBIRT services and to bill for SBIRT services whenever possible. Through coding and billing, providers can demonstrate to policymakers how SBIRT is being used and how it is making a difference.

SBIRT service reimbursement codes for Medicaid, Medicare and commercial insurance are detailed in this section.

For more information, contact Bonnie Campbell, Maryland SBIRT Project Director, at bonnie.campbell@bhsbaltimore.org or 410-637-1900 ext. 7790.

Medicaid Reimbursement for SBIRT Codes (As of July 1, 2016)

Payor Code Description Fee Schedule
Medicaid W7000 Alcohol and/or substance (other than tobacco) use disorder screening; self-administered $5.14
Medicaid W7010 Alcohol and/or substance (other than tobacco) use disorder screening; provider-administered structured screening (e.g. AUDIT, DAST) $17.13
Medicaid W7020 Alcohol and/or substance (other than tobacco) use disorder intervention; greater than 3 minutes up to 10 minutes $5.71
Medicaid W7021 Alcohol and/or substance (other than tobacco) use disorder intervention; greater than 10 minutes up to 20 minutes $11.42
Medicaid W7022 Alcohol and/or substance (other than tobacco) use disorder intervention; greater than 20 minutes $22.36

Medicare Reimbursement for SBIRT Codes (As of May 7, 2015)

Payor Code Description Fee Schedule
Medicare G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15-30 minutes $29.42
Medicare G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $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

Commercial Insurance Reimbursement for SBIRT Codes (As of May 7, 2015)

Payor Code Description Fee Schedule
Commercial Insurance 99408 Alcohol and/or substance abuse structured screening and brief intervention services; 15-30 min. $33.41
Commercial Insurance 99409 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $65.51