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Provider Notice Issued 05/13/2022

Date:    May 13, 2022 

To:       All Medical Assistance Program Providers 

Re:      Coverage for Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services

_______________________________________________________________________________________________________________________________________________________ This notice announces coverage for Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for dates of service on or after January 1, 2022. These services will be covered for HFS-enrolled customers aged six (6) through 64, when provided by an HFS-approved provider in both the Illinois Medicaid fee-for-service (FFS) and HealthChoice Illinois (HCI) managed care organization plans (MCOs). 

Pursuant to Public Act 102-0598, SBIRT means a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons who are at risk of developing substance use disorders or have substance use disorders including, but not limited to, an addiction to alcohol, opioids, tobacco, or cannabis. SBIRT services include all of the following:  

  1. Screening to quickly assess the severity of substance use and to identify the appropriate level of treatment.
  2. Brief intervention focused on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  3. Referral to treatment provided to those identified as needing more extensive treatment with access to specialty care.

Qualified Community-Based SBIRT Providers

The following enrolled providers are considered eligible for reimbursement for SBIRT services when delivered consistent with HFS policies and provided within their scope of practice consistent with federal or state law, regulation, or policy: Physicians, Physician Assistants (PA), Advanced Practice Nurses (APN), Licensed Clinical Psychologists (LCP), Licensed Clinical Social Workers, (LCSW), Licensed Clinical Professional Counselors (LCPC), Licensed Marriage and Family Therapists (LMFT), Local Health Departments, and Federally Qualified Health Centers (FQHCs), Encounter Rate Clinics (ERCs) and Rural Health Clinics (RHCs) billing a behavioral health encounter. 

SBIRT Service Requirements

Providers seeking to deliver SBIRT services under the Illinois Medical Assistance program must:

  • Utilize either the Alcohol Use Disorders Identification Test (AUDIT) or Drug Abuse Screening Test (DAST) screening tool;
  • Provide immediate face-to-face feedback to the customer regarding the screening results; and
  • Retain a copy of the customer's AUDIT or DAST in the customer's clinical record, including screening results. 

For SBIRT screens that result in a positive screen, the provider must also:

  • Educate the customer regarding the negative consequences of high-risk behaviors associated with alcohol and drug use, seeking to motivate the customer toward behavioral change;
  • As clinically appropriate, use brief intervention techniques to engage the customer in a joint decision-making process related to needed behavior changes; and
  • As clinically appropriate, provide a referral to specialized substance use disorder  (SUD) treatment and a follow-up plan with the customer to support and motivate change.

Clinical Note:  The successful delivery of SBIRT services is correlated with the use of Motivational Interviewing techniques. 

Positive Screen

SBIRT services resulting in the potential identification of behaviors consistent with an existing, or developing, SUD condition (positive screen) should be billed using either: G2011, G0396, or G0397, depending upon the total time spent in the delivery of service, consistent with HFS billing standards. 

Negative Screen

SBIRT services that fail to identify a potential SUD condition should be billed using H0049, when:

  • The result of the SBIRT screen was negative, and
  • There was no clinical indication that a referral for additional SUD intervention is necessary.

 

Referral for Treatment

SBIRT services that result in a clinically appropriate referral for specialized SUD services must be made to a Department of Human Services/Substance Use Prevention and Recovery (DHS-SUPR) licensed community-based provider of SUD treatment services. Providers seeking to identify a qualified DHS-SUPR licensed community-based provider of SUD services may utilize the DHS Illinois Helpline website: https://hub.helplineil.org/findhelp.

 

Qualifying Community-Based SBIRT Procedure Codes

The following Healthcare Common Procedure Coding System (HCPCS) codes will be used by the qualified community-based SBIRT providers, as identified in this notice.

 

CodeDescriptionService Time
G2011Alcohol and/ or substance (other than tobacco) abuse structured screening/assessment and brief intervention5 to 14 minutes
G0396Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention15 to 30 minutes
G0397Alcohol and/or substance (other than tobacco) abuse structured assessment and interventionGreater than 30 minutes
H0049Alcohol and/ or drug screening (Negative Screen)Event

 

The reimbursement rates for the services can be found in the Practitioner Fee Schedule and Licensed Practitioner of the Healing Arts Fee Schedule utilized by the qualified providers identified in this notice.   

Billing Note: A qualified provider may bill on the 837P only one SBIRT HCPCS code, per customer, per day.

 

CodeDescriptionService Time
G2011Alcohol and/ or substance (other than tobacco) abuse structured screening/assessment and brief intervention5 to 14 minutes
G0396Alcohol and/or substance (other than tobacco) abuse structured assessment and brief intervention15 to 30 minutes
G0397Alcohol and/or substance (other than tobacco) abuse structured assessment and interventionGreater than 30 minutes
H0049Alcohol and/ or drug screening (Negative Screen)Event

Opioid-Specific SBIRT Services and Initiation of Medication Assisted Treatment (MAT) in a Hospital Emergency Department 

Additionally, PA 102-0598 requires coverage of SBIRT services in a hospital emergency department (ED) which includes the initiation of MAT for an opioid use disorder. Hospitals seeking reimbursement for opioid-specific SBIRT services must provide and document:

  • All necessary consents and releases of information;
  • SBIRT services consistent with the SBIRT service requirements of this notice;
  • A referral for specialized SUD services to a DHS-SUPR licensed community-based provider of SUD treatment services;
  • The initiation of MAT in the ED;
  • A referral for the ongoing provision of MAT services to a qualified provider; and
  • Notification to the customer's primary care physician (PCP) of the initiation of MAT services. 

Hospitals seeking reimbursement for opioid specific SBIRT services should use HCPCS code G2213, along with all other relevant HCPCS codes, when submitting an 837I claim to HFS or the customer's MCO. Reimbursement for G2213 shall be made consistent with HFS EAPG pricing or MCO established reimbursement methodologies.

 

CodeDescriptionService Time
G2213Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (List separately in addition to code for primary procedure).Event

 

Hospitals cannot bill for both SBIRT (G2011, H0396, H0397, or H0049) and initiation of MAT (G2213) at the same time. G2213 is the add-on to the primary emergency procedure for initiation of MAT.  

Questions may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or to the applicable HCI MCO plan.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs


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JB Pritzker, Governor • Theresa Eagleson, Director