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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 7 Screening, Brief Intervention, and Referral to Treatment (SBIRT) : 7.5 Reimbursement and Limitations

SBIRT is limited to clients who are 10 years of age and older.
SBIRT is limited to up to two screening sessions per rolling year. A screening that results in a negative result does not require a brief intervention. In these instances procedure code H0049 should be used. A provider may re-screen a client within the same rolling year to determine whether a client’s substance use behavior has changed.
Procedure code 99408 should be used when a brief intervention follows an SBIRT screening. Procedure code 99408 is limited to once per day. SBIRT is limited to four sessions per rolling year when it constitutes a screening followed by a brief intervention.
If a client requires more than four combined screening and brief intervention sessions per rolling year, the client must be referred for substance abuse treatment.
SBIRT is not reimbursable to providers (whether licensed or non-licensed) who have not completed the required number of training hours in SBIRT methodology.
Procedure codes 99408 and H0049 will be denied if billed for the same date of service as any of the following procedure codes:
Procedure codes 99408 and H0049 cannot both be billed on the same date.
Physicians and other qualified health care professionals that bill an Evaluation and Management (E/M) code for a visit where SBIRT occurred must use modifier 25 to identify a significant, separately identifiable E/M service rendered by the same provider on the same date of service.

Texas Medicaid & Healthcare Partnership
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