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 [email protected] 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 |
Related Links
Coding for Screening and Brief Intervention Reimbursement, SAMHSA
Maryland Medical Assistance Program Transmittal 06/08/16 – Behavioral Health Providers
Maryland Medical Assistance Program Transmittal 06/08/16 – FQHC
Maryland Medical Assistance Program Transmittal 06/08/16 – General Providers