CO · guidance

CO HCPF Screening, Brief Intervention and Referral to Treatment (SBIRT) Program — SBIRT Billing Information

SBIRTBillingInformation

activein force · 2026-07-26 – presentas-observed

TheprocedurecodesusedtoreportSBIRTservicesforreimbursementareconsistentamongallprovidertypes.ThissectionwillprovideacomprehensiveoverviewoftheelementsnecessarytoreportSBIRTservicesinvariousbillingscenarios.AprovidermaynotsubmitaclaimcontainingbothCurrentProceduralTerminology(CPT)andHealthcareCommonProceduralCodingSystem(HCPCS)codes.TheprovidermustuseeithertheCPTortheHCPCScodesdesignatedforSBIRTservices.

Currently,ColoradoSBIRThascodesonlyforthescreeningandbriefinterventionservicesfor15-30minutes(procedurecode99408)orgreaterthan30minutes(procedurecode99409).IfbillinganE/Mserviceandeither99408or99409onaclaim,providersshouldusemodifier–25toindicatethattheE/Mserviceisseparatelyidentifiable.EnsuretheE/Mserviceisdocumentedandcodedappropriately.

ProcedurecodeH0049canbebilledwhenafullscreeningisconductedandtheresultisnegative.H0049maybebilledinadditiontotheE/Mcodeforthevisit.

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HealthFirstColoradoacceptsprocedurecodesthatareapprovedbytheCentersforMedicare&MedicaidServices(CMS).TheprocedurecodesareusedtosubmitclaimsforservicesprovidedtoHealthFirstColoradomembersandrepresentservicesthatmaybeprovidedbyenrolledcertifiedHealthFirstColoradoproviders.

TheHealthcareCommonProceduralCodingSystem(HCPCS)aredividedintotwo(2)principalsubsystems,referredtoaslevelIandlevelIIoftheHCPCS.LevelIoftheHCPCSiscomprisedofCPT,anumericcodingsystemmaintainedbytheAmericanMedicalAssociation(AMA).

TheCPTisauniformcodingsystemconsistingofdescriptivetermsandidentifyingcodesthatareusedprimarilytoidentifymedicalservicesandproceduresfurnishedbyphysiciansandotherhealthcareprofessionals.LevelIIoftheHCPCSisastandardizedcodingsystemthatisusedprimarilytoidentifyproducts,supplies,andservicesnotincludedintheCPTcodes,suchasambulanceservicesanddurablemedicalequipment,prosthetics,orthotics,andsupplies(DMEPOS)whenusedoutsideaphysician'soffice.LevelIIcodesarealsoreferredtoasalpha-numericcodesbecausetheyconsistofasinglealphabeticalletterfollowedbyfour(4)numericdigits,whileCPTcodesareidentifiedusingfive(5)numericdigits.

TheHealthInsurancePortability&AccountabilityActrequiresproviderstocomplywiththecodingguidelinesoftheAMACPTProcedureCodesandtheInternationalClassificationofDisease,ClinicalModificationDiagnosisCodes.Ifthereisnotimedesignatedintheofficialdescriptor,thecoderepresentsone(1)unitorsession.

VisittheBulletinswebpageformonthlybulletins,whichincludeupdatesonapprovedprocedurescodesandthemaximumallowableunitsbilledperprocedure.VisittheProviderNewswebpagetosignupforproviderbulletincommunications.

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PolicyguidanceforNCCIprovidedinthismanualdoesnotsupersedeFederalNCCIpolicy.ItispublishedtoassistprovidersinunderstandinghowtheHealthFirstColoradoSBIRTbenefitisaffectedbyNCCIedits.HealthFirstColorado'spolicyistoallowSBIRTcodestobebilledonthesamedayasotherEvaluation&Management(E&M)services(10CCR2505-108.747.6.C)

NCCIProcedure-to-procedure(PTP)billingeditsaffectSBIRTcodes.PursuanttotheNationalCorrectCodingInitiativePolicyManual(revision1/1/2016-ChapterXI-Page9),ifaproviderreportstheSBIRTcodes99408and99409withanE&M,psychiatricdiagnostic,orpsychotherapycodeutilizinganNCCIPTP-associatedmodifier,theprovideriscertifyingthattheSBIRTcodeserviceis:

Adistinctandseparateserviceperformedduringaseparatetimeperiod(notnecessarilyaseparatememberencounter)thantheE&M,psychiatricdiagnostic,orpsychotherapyserviceand,

IsaservicethatisnotincludedintheE&M,psychiatricdiagnostic,orpsychotherapyservicebasedontheclinicalreasonfortheE&M,psychiatricdiagnostic,orpsychotherapyservice.

IftheE&M,psychiatricdiagnostic,orpsychotherapyservicewouldnormallyincludeassessmentand/orinterventionofalcoholorsubstanceabusebasedonthemember'sclinicalpresentation,SBIRTcodesmaynotbeadditionallyreported.

Providersmayattachbypassmodifiers(typically'25'or'59')to99408-and99409-lineitemswhichallowthoselineitemstobereimbursedinadditiontotheE&Mcode.VisittheCentersforMedicare&MedicaidServices(CMS)NCCIwebpageforfurtherinstructiononNCCIeditsandbypassmodifieruse.

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ProcedureCode

Description

Modifier

AncillaryDiagnosis

UnitofService

PriorAuthorizationRequired

99408

Alcoholand/orsubstance(otherthantobacco)abusestructuredscreening(eg,AUDIT,DAST),andbriefintervention(SBI)services;15to30minutes.

Modifier25or59maybeappliedtobypassNCCIedits.

Z71.41Z71.51

Limitone(1)perday,four(4)perstatefiscalyear.Eachsessionislimitedtotwo(2)unitspersession,at15minutesperunit.

NoPA

99409

Alcoholand/orsubstance(otherthantobacco)abusestructuredscreening(eg,AUDIT,DAST),andbriefintervention(SBI)services;greaterthan30minutes.

Modifier59maybeappliedtobypassNCCIedits.

Z71.41Z71.51

Limitone(1)perday,two(2)perstatefiscalyear.

NoPA

Clinicalguidanceforprocedurecodes99408and99409:

Screeningandbriefinterventiondescribesadifferenttypeofmember-physicianinteractionthantheprovisionofgeneraladvice.Itrequiresasignificantamountoftimeandadditionalacquiredskillstodeliver.Screeningandbriefinterventiontechniquesarediscrete,clearlydistinguishableclinicalproceduresthatareeffectiveinidentifyingproblematicalcoholorsubstanceuse.Componentsincludebutarenotlimitedto:

Usingastandardizedscreeningtool

Providingfeedbacktothememberonthescreeningresults

Discussingnegativeconsequencesthathaveoccurredandtheoverallseverityoftheproblem

Motivatingthemembertowardbehavioralchange

Ajointdecision-makingprocessregardingalcoholand/ordruguse

Discussingandagreeingonplansforfollow-upwithmember

Ancillarystaff,includinghealtheducators,mayperformSBIRTservicesunderthesupervisionofacredentialedprovider.Theservicesshouldrelatetoaplanofcareandwillrequirebillingunderthesupervisingphysician.SBIRTscreeningandbriefinterventionthatdoesnotmeettheminimum15-minutethresholdisnotseparatelyreimbursable.Thesearetime-basedcodes;therefore,documentationmustdenotestart/stoptimeortotalface-to-facetimewiththemember.Duetoprocedurecode99409beinginclusiveofthetimespentbefore30minutesisaccumulated,thetwo(2)procedurecodesmaynotbebilledtogetheronthesamedateofservice.Bothprocedurecodesaccountforscreeningandbriefintervention,thereforestatefiscalyearlylimitsforscreeningandbriefinterventionapplytoeach.

Procedurecode99408/procedurecode99409mayonlybebilledwhenalltheseconditionsaremet:

Whenafullscreenispositive

Whentheyaccountforthetimeoffullscreening,briefinterventionand/orreferraltotreatment

Note:ThestatefiscalyearisJuly1throughJune30.

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ProcedurecodeH0049-Alcoholand/ordrugscreening,(untimed)

ProcedureCode

Description

Modifier

AncillaryDiagnosis

UnitofService

PriorAuthorizationRequired

H0049

Alcoholand/ordrugscreening(e.g.,AUDIT,DAST,CRAFFT,etc.)

Modifier59maybeappliedtobypassNCCIedits.

Z13.9

Limitone(1)perday,two(2)perstatefiscalyear.

NoPA

Afullscreenwillfrequentlybenegative,andthememberwillnotrequirebriefinterventionorreferraltotreatment.TheseinstancesarestillreimbursableusingtheHCPCSprocedurecodeH0049.WhenusingprocedurecodeH0049,aunitofserviceisequivalenttothetotalamountoftimerequiredtoadministerthescreening.Therefore,whenbillingthescreeningtheunitsofserviceshouldalwaysequalone(1)regardlessoftimespentcompletingthescreening.

ProcedurecodeH0049mayonlybebilledwhenalltheseconditionsaremet:

Itfollowedapositivepre-screen

Thefullscreenwasnegative

Abriefinterventionorreferraltotreatmentwasnotnecessary

ProcedurecodeH0049maynotbebilledinconjunctionwithprocedurecode99408orprocedurecode99409becausethosetwo(2)codesarealsoinclusiveofafullscreening.

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DiagnosiscodesplayacriticalroleinsupportingthemedicalnecessityoftheCPTorHCPCScodesthatarebilled.Belowaretablesofcommonancillary(non-principal)diagnosiscodesforreportingSBIRTservices,andallowablecodesforreportingtheplaceofserviceforprovidingSBIRTservices.

AncillaryICD-10CodesforSBIRT

ICD-10Code

Description

Z13.9

Encounterforscreening,unspecified

Z71.41

Alcoholabusecounseling&surveillanceofalcoholic

Z71.51

Drugabusecounselingandsurveillanceofdrugabuser

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Code

Description

School

Office

Home

InpatientHospital

OutpatientHospital

EmergencyRoomHospital

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SBIRTthatisprovidedinthehospitalemergencydepartmentmaybebilleddirectlytoHealthFirstColoradobytherenderingphysicianormaybeincludedinthehospitalclaim,butneverboth.

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ReimbursementforSBIRTisincludedintheencounterratepayment.NoseparatereimbursementforSBIRTisallowableinthesesettings.ProvidersmuststillattachprocedurecodesH0049,99408,or99409andtheappropriateancillarydiagnosiscodestotheencounterclaim.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 3b8874665c281a3af629cd93ad1f7439e972759af23971b1cca480debe9ca65b

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