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Outpatient Facility Coding Alert

Reader Question:

Here's How to Get Paid for Substance Abuse Treatment

Published on Tue Dec 06, 2016 Print Friendly and PDF PDF

Question: The provider treated a patient with substance abuse. His consultation covered establishment of a treatment plan, diagnosis, and patient education regarding diagnosis and treatment in a substance abuse treatment setting. Can you advise as to the billing codes and reimbursement rates for these services, and where I could find additional information regarding the documentation needed to meet these billing requirements?

Mississippi Subscriber

Answer: There are two codes you can use to report for these procedures: 99408 (Alcohol and/or substance [other than tobacco] abuse structured screening [eg, AUDIT, DAST] and brief intervention [SBI] services; 15 to 30min) and 99409 (Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes). For these codes, the code would be “N” implying “Non-covered Services.” Medicare does not cover these services. So, for a Medicare patient, you may use the codes G0396 (Alcohol and/or substance [other than tobacco] abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes) and G0397 (… greater than 30 minutes). The RVU values for these codes would be:

  1. G0396 = 1.01 (Nonfacility) and 0.95 (Facility); and
  2. G0397 = 2.01 (Nonfacility) and 1.94 (Facility).

You may refer to the following link to identify the documents requirement for billing these codes: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf.

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