For emergency department services, SBI can be delivered a physician or other health care provider who bills independently for services, a hospital employee, or an independent substance use treatment organization under contract with the hospital.

A physician or other health care provider (including providers under the supervision of a physician or other health care provider, such as residents and social workers) could bill using the new CPT codes, G codes for Medicare, or HCPCS codes for Medicaid (in a very few states). The hospital would also bill for the facility portion of the service delivered.

If SBI is delivered by a salaried employee of the hospital, the service would be built into the facility charge and likely would not be separately billed.

The delivery of SBI by an independent contractor is exemplified by the San Diego SBIRT program where SBI is delivered by a specialty substance use treatment system under contract with the hospital. Such an approach also allows for using the new CPT, G or HCPCS codes.

Recommended codes:

CPT
99408           Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes 
99409           greater than 30 minutes

Medicare
G0396             Alcohol and/or substance (other than tobacco) abuse structured assessment (AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes  
G0397             greater than 30 minutes  

Medicaid
H0049            Alcohol and/or drug screening.
H0050            Alcohol and/or drug services, brief intervention, per 15 minutes. 

Other Codes (cannot be used with recommended codes)

• Screening99281 - 99285 (emergency department services)
• Brief Intervention99281 - 99285 (emergency department services)
• 99401 -99405 (preventive counseling, risk factor reduction)

SBI provided by a hospital employee (social worker, nurse, health educator, or other mental health practioner)

• Screening99281 - 99285 (emergency department services)
• Brief Intervention99281 - 99285 (emergency department services)
• 99401 - 99405 (preventive counseling, risk factor reduction)
• SBI provided by an independent, licensed substance use treatment agency (or other agency under contract with the hospital to provide SBI services)

Screening

• 99801 (psychiatric diagnostic exam)
• H0001 (AOD assessment)
• H0002 (AOD screening for treatment admission)
• Brief Intervention99804 - 99809 (psychotherapy)
• H0004, H0005, H0016 (AOD counseling, therapy)