Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical/Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.20 Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SBIRT is a comprehensive, public health approach to the delivery of early intervention and treatment services for clients with substance use disorders and those at risk of developing such disorders. Substance abuse includes, but is not limited to, the abuse of alcohol and the abuse of, improper use of, or dependency on illegal or legal drugs. SBIRT is used for intervention directed to individual clients and not for group intervention. SBIRT is targeted to clients who are from 14 years of age through 20 years of age and who present to the hospital emergency department for a traumatic injury, condition, or accident related to substance abuse. SBIRT may also be medically necessary for clients who are from 10 years of age through 13 years of age.
Claims for the first SBIRT session, including screening and brief intervention, must be submitted by the hospital using an appropriate revenue code and procedure code H0050. Screening to identify clients with problems related to substance use must be performed during the first session in the hospital emergency department or inpatient setting, but will not be separately reimbursed.
Screening may be completed through interview and self-report, blood alcohol content, toxicology screen, or by using a standardized tool. Standardized tools that may be used include, but are not limited to, the following:
Brief intervention is performed during the first session following a positive screen or a finding of at least a moderate risk for substance or alcohol abuse. Brief intervention, directed to the client, involves motivational discussion focused on raising the client's awareness of their substance use and its consequences, and motivated them toward behavioral change. Successful brief intervention encompasses support of the client's empowerment to make behavioral changes. A client found to have a moderate risk for substance or alcohol abuse should be referred for brief treatment of up to 3 sessions. Upon determination that the client has a severe risk for substance or alcohol abuse, the client should also be referred for more extensive treatment to the appropriate chemical dependency treatment center or outpatient behavioral health provider. If the client is currently under the care of a behavioral health provider, the client must be referred back to that provider.
SBERT documentation for the first session must include:
The provider who performed the screening must document that a follow-up appointment was made for a subsequent session.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.