SBIRT Services Expanded for Medicare
Take a quick look at what’s new. In a July 2025 MLN Connects newsletter, the Centers for Medicare & Medicaid Services (CMS) advised of changes to the Screening, Brief Intervention & Referral to Treatment (SBIRT) services for substance abuse disorders (SUDs). CMS defines SBIRT as an integrated, comprehensive public health approach for the delivery of early intervention and treatment services to individuals with SUDs and those at risk of developing these disorders. SBIRT practices consist of primary care offices (including pediatric providers); federally qualified health centers (FQHCs); school-based and community health centers; hospital systems including hospital emergency rooms, trauma centers, and children’s hospitals; behavioral health centers; and other community settings. Understand SBIRT Approach CMS advises that using an SBIRT approach can decrease drug and alcohol use severity, reduce risk of physical trauma, reduce the percentage of patients who go without specialized treatment, and, ultimately, reduce healthcare costs. There are three key components of SBIRT: CMS has resources for providers, including assessment and screening tools like the Alcohol Use Disorders Identification Test (AUDIT) Manual and the Drug Abuse Screening Test (DAST). Follow These Telehealth Updates CMS made substantive content changes to SBIRT, including updating telehealth requirements and services, opioid treatment program coverage, and SUD screening and intervention. For telehealth, CMS is changing coverage, and the changes go into effect at the end of this month. Right now, SBIRT services can be provided via interactive telecommunications, including two-way, interactive, audio-only technology, to diagnose, evaluate, or treat certain SUDs if the patient is in their home (these services will be covered through Sept. 30, 2025). Payments for these services are made at the non-facility Medicare Physician Fee Schedule (MPFS) rate. Telehealth E/M visits can provide medication management services. Controlled medications like buprenorphine can be prescribed through telehealth to make sure patients take medications properly in their recovery process are covered through Dec. 31, 2025. See the Medicare Learning Network (MLN) Evaluation and Management Services booklet for more information. Note These OTP Coverage Changes Opioid treatment program (OTP) coverage expanded to include coordinated care and referral services, patient navigational services, and peer recovery support services, as well as several medication treatments, including: Additionally, OTP services can be provided through two-way audio-video interaction for substance use counseling and individual and group therapy services included in the bundled payment, the add-on code for additional counseling and therapy, intake activities and periodic assessments, and initiation of treatment with buprenorphine. These services can be provided through audio-only interaction (for example, phone calls) when audio-video communication isn’t available to the patient, or the patient isn’t capable of, or doesn’t consent to, using devices that permit a two-way audio-video interaction — provided the OTP meets all other applicable requirements. OTPs can use the intake add-on HCPCS billing code G2076 (Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code) when they start methadone treatment with audio-only devices. CMS allows this if the patient is with a licensed practitioner who can prescribe and dispense controlled medications and if audio-video technology isn’t available or practical. Important: The licensed practitioner must be in the same room as the patient to perform the visual part of the exam. Check Out These SUD Service Expansions SUD screening and intervention services now include safety planning intervention (SPI) for patients in crisis, which is an intervention for patients who are determined to have an elevated risk for suicide, including risky substance use. Additionally, post-discharge phone follow-up contact intervention (FCI) can be utilized for patients with suicide risk, including overdose. These services involve a series of phone contacts, up to four calls per calendar month, between a provider and the patient in the weeks and sometimes months following any instance in which the patient has been discharged following a crisis encounter. A crisis encounter can include release from an ED, psychiatric inpatient care, or crisis stabilization. There is now coverage for medication for opioid use disorder (MOUD) treatment in the ED. For all the details, including more on proper billing, click the MLN Connects link above; and check out the OTP page at CMS to learn more and discover links to other valuable resources. Patricia Zubritzky, BS, CRCE-I, Contributing Writer, Pittsburgh
