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Implications of SBIRT for early identification of substance use disorder

September 16, 2016
by Paige Pennington
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Everyone in the addiction treatment recovery industry knows that too many Americans never receive addiction treatment because their disorders go completely undiagnosed. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that has been clinically shown to identify, reduce and prevent substance misuse and the disease of addiction and ultimately reduce healthcare costs. While implementation barriers still exist, the Affordable Care Act has created valuable opportunities for the expansion of SBIRT utilization across various healthcare settings.

SBIRT is an early intervention approach that can be used in primary care settings to identify individuals at risk for substance use disorder. This approach targets individuals with non-dependent substance use to provide intervention prior to the need for more extensive treatment. Healthcare practitioners are encouraged to utilize SBIRT for patients who may not be actively seeking treatment for substance abuse, but who are at risk for developing medical complications or whose substance use may interfere with other responsibilities such as work and family matters.

Early intervention for patients with the potential for being diagnosed with substance use disorder is a priority for federal and commercial health plans. While there are obviously benefits of early treatment for the patient, utilizing SBIRT has the potential to lower costs to healthcare programs by shortening the time needed for treatment by identifying the issue at a less severe stage and reducing the likelihood of the patient developing costly comorbidities as the result of long-term substance abuse.

SBIRT consists of three major components:

  • Structured Assessment or Screening – Identifying risky substance use behaviors using standardized assessment tools.
  • Brief Intervention – Engaging the patient in a short conversation, providing feedback and guidance.
  • Referral to Treatment – Providing a referral to brief therapy or additional treatment to patients whose assessment or screening shows a need for such additional services.

Who can administer and bill for SBIRT?

SBIRT can be administered in a primary healthcare setting, such as a physician’s office or outpatient hospital by a physician, physician assistant, nurse practitioner, clinical nurse specialist, clinical psychologist, clinical social worker, or a certified nurse-midwife. Reimbursement for SBIRT is available through commercial insurance, Medicare and Medicaid.[1] The Centers for Medicare & Medicaid Services (CMS) published guidance for Medicare and Medicaid providers utilizing SBIRT services, including documentation standards.[2] While Medicare currently pays for screening and brief intervention as a preventive service in the primary care setting, some states are working to “activate” Medicaid codes for SBIRT reimbursement.

According to the most recent information from the Substance Abuse and Mental Health Services Administration (SAMHSA), 16 states have approved SBIRT codes in their respective Medicaid plans; of these, five states have activated codes that allow providers to bill and receive payment for the services, four have activated SBIRT codes to allow for reimbursement of non-physician professionals (including Alaska, Tennessee, Colorado, and Virginia) and two states (Indiana and Oklahoma) have activated SBIRT codes to allow for reimbursement of physicians only.[3]





Commercial Insurance

CPT 99408

Alcohol and/or substance abuse structured screening and brief intervention; 15-30 minutes

CPT 99409

Alcohol and/or substance abuse structured screening and brief intervention; greater than 30 minutes



Alcohol and/or substance abuse structured screening and brief intervention;15-30 minutes


Alcohol and/or substance abuse structured screening and brief intervention; greater than 30 minutes



Alcohol and/or drug screening


Alcohol and/or drug screening, brief intervention; per 15 minutes


Implementing SBIRT

Following the backlash by commercial insurers who have been inundated with claims for substance abuse treatment, CMS has released more information about Medicare and Medicaid coverage for substance abuse services. Untreated substance abuse issues will only cost commercial insurers and federal programs more money in the long run, so it is in the interest of all healthcare programs to publicize approaches targeting early intervention.[4]