This bulletin informs LME-MCOs and providers about the amendments made to providers types eligible to bill the Screening, Brief Intervention and Referral to Treatment (SBIRT) CPT codes effective as of March 1, 2021. The addition of these licensed professionals as eligible providers is a part of the implementation of the Centers for Medicare and Medicaid Services (CMS) 1115(a) Substance Use Disorder (SUD) Demonstration Waiver. A primary goal of the SUD Demonstration Waiver is to improve access to the full continuum of American Society of Addiction Medicine (ASAM) levels of care. The SBIRT CPT codes meet the criteria for ASAM Level 0.5 Early Intervention.
“SBIRT is an early intervention approach for individuals with nondependent substance use to effectively help them before they need more extensive or specialized treatment. SBIRT services are simple to use in primary care settings so you can systematically screen and assist people who may not seek help for a substance use problem. SBIRT services:
- Reduce health care costs
- Decrease severity of drug and alcohol use
- Reduce risk of physical trauma
- Reduce the percent of patients who go without specialized treatment.”
It is a public health approach to screening and early intervention to help identify, reduce and prevent SUDs. The CPT codes include:
- 99408- Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
- 99409- Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
In addition to physicians, physician assistants and nurse practitioners, the following provider types will be eligible to bill these CPT codes:
- Licensed Psychologist (LP)
- Licensed Psychological Associate (LPA)
- Licensed Clinical Mental Health Counselor (LCMHC)
- Licensed Clinical Mental Health Counselor Associate (LCMHCA)
- Licensed Clinical Social Worker (LCSW)
- Licensed Clinical Social Worker Associate (LCSWA)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Marriage and Family Therapist Associate (LMFTA)
- Licensed Clinical Addiction Specialist (LCAS)
- Licensed Clinical Addiction Specialist Associate (LCASA)
- Certified Clinical Nurse Specialist (CNS)
Contact
NCTracks Call Center: 800-688-6696