Screening, Brief Intervention and Referral to Treatment (SBIRT)

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Effective with dates of service on or after July 1, 2014, the following codes and billing procedures must be utilized in order to receive payment for the Screening, Brief Intervention and Referral to Treatment (SBIRT) services.

The South Carolina Department of Health and Human Services (SCDHHS) began coverage for SBIRT in 2011 to improve birth outcomes and the overall health of moms and babies. SCDHHS has partnered with stakeholders across the state to help identify and treat pregnant beneficiaries who may experience alcohol or other substance abuse issues, depression, tobacco use or domestic violence. SBIRT services (screening and, when applicable, a brief intervention) are reimbursable in addition to an Evaluation and Management (E/M) code for pregnant women and/or those who are in the 12-month postpartum period.

SCDHHS will continue to use the Healthcare Common Procedure Coding System (HCPCS) codes of H0002 for screening and H0004 for intervention. The U1 modifier will no longer be covered as of July 1, 2014.  A new modifier, HD, will now be required when the services rendered indicate a positive result and/ or when a referral is completed.

Providers must use the H0002 HCPCS code and the HD modifier when an SBIRT sceening result is positive.  Additionally, providers must use the H0004 HCPCS code with the HD modifier when a referral to treatment is made in conjunction with the brief intervention. These changes in billing procedures apply for Healthy Connections Medicaid members enrolled in both the Medicaid Fee for Service (FFS) and Medicaid Managed Care program.

 

  • Screening - H0002 reimburses at $24.00 once per fiscal year.
  • Brief Intervention - H0004 reimburses at $48.00 twice per fiscal year.

 

Procedure

Code

Screening 

H0002

Positive Screen

H0002 HD modifier

Brief Intervention

H0004

Brief Intervention Resulting in a Referral

H0004 HD modifier

 

For questions regarding this policy or to schedule an SBIRT training, please contact Allison Lukacic at (803) 898-2128 or lukacic@scdhhs.gov.  Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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