CMS Pub. 100-04, ch. 4, § 200.6

Assessment and Intervention Services

(Rev. 1445, Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08)

For CY 2008, the CPT Editorial Panel has created two new Category I CPT codes for

reporting alcohol and/or substance abuse screening and intervention services. They are

CPT code 99408 (Alcohol and/or substance (other than tobacco) abuse structured

screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes);

and CPT code 99409 (Alcohol and/or substance (other than tobacco) abuse structured

screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30

minutes). However, screening services are not covered by Medicare without specific

statutory authority, such as has been provided for mammography, diabetes, and colorectal

cancer screening. Therefore, beginning January 1, 2008, the OPPS recognizes two

parallel G-codes (HCPCS codes G0396 and G0397) to allow for appropriate reporting

and payment of alcohol and substance abuse structured assessment and intervention

services that are not provided as screening services, but that are performed in the context

of the diagnosis or treatment of illness or injury.

Contractors shall make payment under the OPPS for HCPCS code G0396 (Alcohol

and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST)

and brief intervention, 15 to 30 minutes) and HCPCS code G0397, (Alcohol and/or

substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and

intervention greater than 30 minutes), only when reasonable and necessary (i.e., when the

service is provided to evaluate patients with signs/symptoms of illness or injury) as per

section 1862(a)(1)(A) of the Act.

HCPCS codes G0396 and G0397 are to be used for structured alcohol and/or substance

(other than tobacco) abuse assessment and intervention services that are distinct from

other clinic and emergency department visit services performed during the same

encounter. Hospital resources expended performing services described by HCPCS codes

G0396 and G0397 may not be counted as resources for determining the level of a visit

service and vice versa (i.e., hospitals may not double count the same facility resources in

order to reach a higher level clinic or emergency department visit). However, alcohol

and/or substance structured assessment or intervention services lasting less than 15

minutes should not be reported using these HCPCS codes, but the hospital resources

expended should be included in determining the level of the visit service reported.