SUBSTANCE USE CODES
Maximize Revenue & Help Patients Find the Resources They Need
Below are some coding options for patients with substance use disorders. These are billable services with Medicare, Medicaid, and commercial payers, most often with NO deductible or co-payment to patients for these preventative services
NeuroFlow offers two primary screening options for substance use disorders, including the AUDIT-C and DAST-10.
NeuroFlow auto-scores these questionnaires. The following results would indicate the SBIRT services may be warranted.
AUDIT-C (Positive Result)
AUDIT-C is scored as negative or positive.
- Positive result for males is a score of 4 or more
- Positive score for females is a score of 3 or more
DAST-10 (Moderate or Above)
DAST-10 is scored in 5 severity levels as noted below:
- None (0), no action needed
- Low level (1-2), re-assess at a later date
- Moderate level (3-5), consider brief intervention as next step
- Substantial level (6-8), consider brief intervention as next step
- Severe level (9-10), consider brief intervention as next step
Click here to view more screening and assessment tools recommended by the National Institute on Drug Abuse (NIDA).
Brief interventions are designed to motivate individuals at risk of substance abuse and related health problems to change their behavior by helping them understand how their substance use puts them at risk and to reduce or give up their substance use.
Healthcare providers can also use brief interventions to encourage those with more serious dependence to accept more intensive treatment within the primary care setting or a referral to a specialized alcohol and drug treatment agency.
In primary care settings, brief interventions last from 5 minutes of brief medical advice to 15-30 minutes of brief counseling. Brief interventions are not intended to treat people with serious substance use disorders, but rather to treat problematic or risky behaviors associated with substance use.
The two most common behavioral therapies used in SBIRT programs are brief versions of cognitive behavioral therapy and motivational interviewing, or some combination of the two. To assist you, click the link below for a list of motivational interviewing questions.
Click here for a list of questions to help guide this conversation with your patient.
Reference: BNI‐ART Institute, Boston University School of Public Health
Referral to treatment is a critical yet often overlooked component of the SBIRT process. It involves establishing a clear method of follow-up with patients that have been that have been identified as having a possible substance use disorder or that are in need of specialized treatment.
Appropriate referrals may include:
- Outpatient counseling
- Needle or Syringe Exchange Programs
- Medication-Assisted Treatment (Suboxone or methadone)
- Health Education
- Primary Care Services
- Case Management
- Peer Support Groups (AA/NA)
Click here for a fillable referral form you can use at your practice
Note: Download this form and complete on Adobe Reader or Acrobat to digitally sign
This form can be sent to your patient through NeuroFlow (“custom assignment”) so they have it on hand when they go for follow-up.
As the final step, be sure to document the time you spent screening, conducting brief interventions, and referring the patient. This is a time based code, so record start and stop times or total face-to-face time with the patient.
Example: Spent 3 minutes assigning and reviewing AUDIT-C assessment. Conducting motivational interviewing with patient for 3 minutes. Spent 5 minutes providing a referral to patient to our co-located psychologist for outpatient psychotherapy and health education.
For each patient encounter, document:
- Assessment, clinical impression, and diagnosis
- Date and legible identity of provider
- Physical examination findings and prior diagnostic test results
- Plan of care
- Reason for encounter and relevant history
SBIRT can be conducted in-person or during a telehealth visit.
SBIRT Billing Codes
HCPCS Code G2011
Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT-C), and brief intervention, 5–14 minutes
*Click here for detailed AAPC coding sheet for G2011*
Note: Does not require a referral to treatment; G2011 is also commonly used by commercial payers
HCPCS Code G0396
Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., DAST-10), and brief intervention 15 to 30 minutes
Note: Commercial payers may use CPT Code 99408
*Click here for detailed AAPC coding sheet for 99408*
HCPCS Code G0397
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention, greater than 30 minutes
Note: Commercial payers may use CPT Code 99409
Alcohol Use Billing Codes
There are additional codes for alcohol use that do not require referral to treatment.
HCPCS Code G0442
Annual alcohol misuse screening – billable for completion and review of AUDIT-C assessment
*Click here for detailed AAPC coding sheet for G0442*
HCPCS Code G0443
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes – billable up to 4 times per year.
Use this time to provide the Alcohol Use 101 template to patients after identifying a positive AUDIT-C result.
*Click here for detailed AAPC coding sheet for G0443*
Click here to learn more about coding for SBIRT services
Click here for additional guidance on SBIRT from CMS
If you identify a patient that uses tobacco, assign a patient the Tobacco Cessation 101 or Tobacco Cessation 102 templates on NeuroFlow. These templates review treatments available, including nicotine replacement therapy, along with the health and financial consequences of continued tobacco use.
Spending the 3 minutes telling your patient that you will be sending them content through NeuroFlow and assigning the template is billable with in-person or telehealth visits. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided.
Tobacco Cessation Billing Codes
Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
CPT Code 99406
Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
*Click here for the detailed AAPC coding sheet for CPT Code 99406*
CPT Code 99407
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
*Click here for the detailed AAPC coding sheet for CPT Code 99407*
Note: Health behavior assessment and intervention services (96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171) should not be reported on the same day.
Click here to learn more about tobacco cessation codes and reimbursement
Click here for a quick guide on billing for tobacco cessation services