$260m in Medicaid substance abuse funds left untouched

$260m in Medicaid substance abuse funds left untouched

Alicia Ault

WASHINGTON–More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the White House Office of National Drug Control Policy (ONDCP), said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See “Coding for SBI Reimbursement”) Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons’ Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Health insurer Aetna Inc. is aiming to have more of its participating physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with physicians. Aetna will offer training to physicians and office managers, with a goal of starting more widespread screening.

Physicians can also find more information about screening and brief intervention at www.sbirt.samhsa.gov.

BY ALICIA AULT

Associate Editor, Practice Trends

Coding for SBI Reimbursement

Fee

Payer Code Description Schedule

Commercial CPT 99408 Alcohol and/or substance abuse $33.41

insurance structured screening and brief

intervention services; 15-30

minutes

CPT 99409 Alcohol and/or substance abuse $65.51

structured screening and brief

intervention services; > 30

minutes

Medicare G0396 Alcohol and/or substance abuse $29.42

structured screening and brief

intervention services; 15-30

minutes

G0397 Alcohol and/or substance abuse $57.69

structured screening and brief

intervention services; > 30

minutes

Medicaid H0049 Alcohol and/or drug screening $24.00

H0050 Alcohol and/or drug service, $48.00

brief intervention, per 15

minutes

Source: Substance Abuse and Mental Health Services

Administration

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