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

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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. 
   

• 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.

 
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.

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.

 
Hospitals cannot bill for both SBIRT (G2011, G0396, G0397, 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