Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 19, 2010 PDF

CMS Clarifies Substance Abuse G Code Guidance

Practices providing alcohol and substance abuse structured assessment and brief intervention (SBIRT) services were in luck when CMS introduced two HCPCS codes for these services in 2008 --but keep in mind, you can only report these codes when you perform the services to diagnose or treat an illness or injury.

According to MLN Matters article SE1013, released last week, SBIRT "is an early intervention approach" to offer intervention strategies to patients with non-dependent substance use before the need for more extensive or specialized treatment arises.

The article explains that the two G codes applying to SBIRT are payable for alcohol and substance abuse assessment and intervention, "but only those services that are performed for the diagnosis or treatment of illness or injury," and when medically reasonable and necessary. The applicable G codes are as follows:

• G0396 -- Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention, 15 to 30 minutes
• G0397 -- ...greater than 30 minutes Keep in mind that if the patient is not an inpatient at the time of treatment, these services fall under the outpatient mental health treatment limitation, which means the expenses recognized for Part B deductible and payment calculations "is limited to 62.5 percent of the Medicare approved amount for those services," as dictated under the outpatient mental health treatment limitation.

To read the complete MLN Matters article, visit www.cms.gov/MLNMattersArticles/downloads/SE1013.pdf.