To implement SBIRT, a healthcare setting must secure financing. To begin, personnel looking to develop an SBIRT program in their community will usually have to present financial data on the benefits of SBIRT. Once payment is secured — whether through Medicaid, Medicare, private insurance, or fee-for-service — a clear financing plan is needed to sustain the activities. Fortunately, information on the cost benefits and the billing and coding for potential reimbursement of SBIRT activities is available.
- General Information / Cost Savings
- Purchasing Services / Insurance
- Medicaid Reimbursement
- Medicare Reimbursement
The SBIRT reimbursement map is an interactive tool designed to help determine whether billing codes are listed on a state’s fee schedule, and, if listed, whether or not they are open for reimbursement (i.e. a billing amount has been assigned to the codes). The digital version of this map was developed by the National SBIRT ATTC, funded by SAMHSA.
Reimbursement for SBIRT
The American Medical Association (AMA) has approved several billing codes that will allow you to be reimbursed for providing screening and brief intervention services. Medical procedures are coded using Common Procedure and Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Screening and brief intervention may be provided in an office, emergency department or inpatient visit for both new and established patients. Virtually all payers use AMA’s Evaluation and Management (E & M) CPT codes to pay physicians' services. Many payers reimburse for independent licensed health practitioners such as advance practice nurses, psychologists, and masters-level social workers. A few will pay for service provided by health professionals under the supervision of a physician. Several CPT codes can be used.
Developed by NORC at the University of Chicago, this document shows the most commonly used codes.
MOSBIRT Cost Savings Brief, created by the Missouri SBIRT project, summarizes data from their project and indicates that any investments in SBIRT are more than adequately offset by money saved through the reduction in serious injury.
Ensuring Solutions, a project of the Center for Integrated Behavioral Health Policy at George Washington University Medical Center in Washington, DC offers detailed information around SBIRT costs and financing.
A Sound Investment: Identifying and Treating Alcohol Problems, a report developed by Ensuring Solutions, makes the business case for screening, identifying, and treating alcohol addiction. This document describes the economic cost to society, as well as the economic benefits of screening and treatment of alcohol dependence.
The Alcohol Cost Calculator is an online tool that estimates the prevalence of alcohol problems in any given population, looks at both the human and economic consequences of alcohol problems, and provides information to help healthcare settings work more effectively to improve access to alcohol treatment.
Purchasing Integrated Services for Substance Use Conditions in Healthcare Settings is an issue brief develop by the Center for Policy Research and Analysis at the Treatment Research Institute that explores the challenges, opportunities, and promising practices associated with financing, purchasing, and implementing appropriate treatment for substance use in primary and other healthcare settings.
Treating Alcohol Problems Through Employment-Based Health Insurance is a research report authored by Ensuring Solutions that provides data on private health insurances and their coverage of alcohol screening and treatment activities.
The Colorado Quick reference guide to billing for SBIRT created by HealthTeamWorks provides useful reference information for billing Medicaid, Medicare, and commercial insurance. The guide also includes sample billing scenarios and “key points to consider” when billing for SBIRT.
Medicaid Reimbursement for Screening and Brief Intervention: Massachusetts’ Preparations provides information from the University of Massachusetts’ SBIRT project on their activities in preparing for Medicaid billing and includes useful information for others looking to bill Medicaid for SBIRT activities.
Screening, Brief Intervention and Referral to Treatment Coding, Billing and Reimbursement Manual, created by the Wisconsin Initiative to Promote Healthy Lifestyles, guides clinic and administrative staff through obtaining Medicare, Medicaid, and commercial insurance payment for SBIRT services.
Sample Change in CPT Code Application for SBIRT shares a sample CPT application for SBIRT-related CPT codes.
CMS released the revised booklet, Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse to help providers “…better communicate with your patients about Medicare-covered screening and behavioral counseling interventions in primary care to reduce alcohol misuse, as well as assist you in correctly billing for these services.”
“Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse” informs Medicare providers to cover annual depression screening for adults in the primary care setting.
Medicare Learning Network at the Centers for Medicare & Medicaid provides a variety of training and educational materials that explain Medicare policy in plain language. MLN delivers planned and coordinated provider education through various mechanisms such as national educational articles, brochures, fact sheets, web-based training courses, videos, and podcasts.
Detailed Information About Coding for SBI Reimbursement is a factsheet containing information related to coding for SBIRT activities for Medicare.
Substance (Other than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services, a primer created by the Medicare Learning Network, provides administrators with billing and coding information, as well as information about provider eligibility.
Summary of Medicare Reporting and Payment of Services for Alcohol and/or Substance (Other than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services is an article for physicians, non-physician practitioners, and other providers submitting claims to Medicare contractors for certain mental health services provided to Medicare beneficiaries such as SBIRT.