Billing for SBIRT

As of January 1, 2014, Washington State Apple Health (Medicaid) providers are able to receive reimbursement  for SBIRT under Medicaid expansion. SBIRT, in Washington state, is now covered by Medicaid, Medicare, and private insurers. More information can be found below on SBIRT Medicaid reimbursement.

 

NEW!!!!  Print the SBIRT billing fact sheet to help your healthcare agency prepare for SBIRT billing.

HCA SBIRT Billing Instructions

Review the 2015 Medicaid Provider Guide from Health Care Authority. See pages 213-217 for instructions on SBIRT.

 

Read More

 

What SBIRT services qualify for billing?

Effective January 1, 2014, Washington State Medicaid providers can bill for SBIRT services. SBIRT services will be covered when provided by, or under the supervision of, a certified physician or other certified licensed health professional within the scope of their practice. SBIRT services under Medicaid include:

 

 

Screening

An evidence-based screening tool, like the AUDIT and DAST, should be used to determine if a patient is at risk for a substance use disorder.  Learn more about the full screens.

 

SBIRT screening occurs during an E/M exam. Screening only is not billable with a separate code.  

 

Brief Interventions

If the patient scores positive on the full screens, they should receive a brief intervention that explores the individual's substance use and enhances the patient's motivation to change their behavior. Learn more about brief interventions.

 

A brief intervention may be provided on the same day as the full screen and is billed in addition to the E/M exam. Breif interventions can also be billed on subsequent days. The brief interventions are limited to four encounters per patient, per provider, per calendar year.

 

Referral to Treatment

If the full screen indicates the patient is at severe risk for a substance use disorder, they should receive a referral to a licensed, certified behavioral health agency for a full assessment and possibly treatment for a substance use disorder. Learn more about referrals to treatment.

 

SBIRT services can be delivered in the following facilities:

  • Office
  • Urgent care facility
  • Outpatient hospital
  • Emergency room-hospital
  • Federally qualified health center (FQHC)
  • Community mental health center
  • Indian health service-free standing facility
  • Tribal 638 free standing facility
  • Homeless Shelter
  • Dental office

 

Who can provide and bill for SBIRT services under Medicaid?

 

SBIRT services must be provided by, or under the supervision of, a certified physician or other certified, licensed health care professional within the scope of their practice. NOT ALL SBIRT SERVICE PROVIDERS CAN BILL FOR SBIRT! Review the list of health care professionals below who can provide and bill SBIRT services once they are registered with HCA as an SBIRT provider.

 

SBIRT Service Providers Under Medicaid (A star indicates the provider can bill):

  • Advanced Registered Nurse Practitioner
  • Mental Health Counselor
  • Marriage and Family Therapist
  • Independent and advanced Social Worker
  • Physician
  • Psychologist
  • Dentist
  • Dental Hygienists
  • Chemical Dependency Professional
  • Licensed Practical Nurse
  • Physician Assistant
  • Registered Nurse

Required Training

As a licensed healthcare professional, you must receive SBIRT training in order to provide or supervise individuals providing SBIRT Services. Health Care Authority requires a minimum of four (4) hours of SBIRT training. There are many training options available. Once you complete an approved SBIRT course, you must submit a copy of your certificate of completion to HCA, along with your National Provider Identifier (NPI) number, prior to billing for SBIRT services. You should also keep a copy of your training certificate on file at the medical facility where you practice.

 

  •  

Mail or fax your SBIRT certificates to:

Provider Enrollment

PO Box 45562

Olympia, WA 98504-5562

Fax:  360-725-2144 

 

 

  •  
PLEASE NOTE: It can take up to two months for HCA to approve your SBIRT certificate and allow for successful billing through Provider One. Please have your billing department submit a copy of your SBIRT training certificate to HCA for successful billing during this time.

 

 

 

 

Troubleshooting Denied Claims

 

Here are some common reasons your SBIRT claims may be denied.

 

  • HCA has not received a copy of your SBIRT training certificate and NPI. Submit your certificate to the address listed above.

 

  • You are not registered with HCA as a Washington Apple Health (Medicaid) Provider.  Enroll here with Health Care Authority. Once you have been approved, resubmit your SBIRT training information.

 

  • You are not an eligible provider type to bill for SBIRT services. Make sure another clinician that can bill at your clinic is registered with HCA as an Apple Health Provider, receives SBIRT training, and submits their certificate to HCA.

 

  • It can take up to two months for HCA to approve your SBIRT certificate and allow you to bill SBIRT services through Provider One. During this time may sure your billing department is submitting a copy of your SBIRT training certificate with your claims. Please check with HCA for any questions about retroactive reimbursements for denied claims.

SBIRT Billing Codes and Medicaid Reimbursements

 

Coverage Type 15-30 Minutes 30+ Minutes
Medicaid 99408 99409
Medicare G0396 G0397
Commercial CPT99408 CPT99409
Facility Setting          99408         99409
Non-Facility Setting $21.03 $40.80
Facility Setting $19.98 $39.75

For more information on Facility Setting and Non-Facility Setting, please review pages 277-280 of the Health Care Authority's Medicaid Provider Guide:  Physician-Related Services/Health Care Professional Services.

 

SBIRT services will be covered by HCA when all of the following conditions are met:

  • The billing provider and service provider have submitted their SBIRT training certificates to HCA
  • The billing provider has an appropriate billing taxonomy to bill for SBIRT
  • The diagnosis code, Z71.41 for alcohol/Z71.51 for drugs (ICD10) or V65.42 (ICD9), has been used
  • The treatment or brief intervention does not exceed the four encounters per client, per provider, per year limit
  • The SBIRT assessment, intervention, or treatment takes place in one of the settings listed above.

 

 

SBIRT Billing Reimbursement Checklist

If you are a Healthcare professionals qualified to bill for SBIRT services, you can submit for reimbursement using your NPI number and the SBIRT CPT codes. SBIRT services may be provided on the same day as other evaluation and management medical services.

 

  •  
  •  
  •  
  •  

I have received the SBIRT four hour training and a copy of the training certificate

 

I am qualified to bill for SBIRT services according to HCA

 

I am a registered Apple Health (Medicaid) provider

 

I have submitted my SBIRT training certificate, along with my NPI number to HCA