Alcohol and/or substance abuse assessment and intervention services

OPPS FINAL RULE The following information was posted in the November 27, 2007, Outpatient Prospective Payment System (OPPS) final rule at www.cms.gov. Alcohol and/or substance abuse assessment and intervention services For CY 2008, two new category I CPT codes have been created to report alcohol and/or substance abuse screening: 99408—Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes); and 99409—Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes). The code descriptions...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes CMS guidance issued in the November 27, 2007 OPPS final rule regarding alcohol and substance abuse assessment and intervention services. It explains the Medicare reporting context for CY 2008, the related CPT and G-code updates, and the distinction CMS draws between screening-oriented services and services furnished in the context of diagnosis or treatment. The content is most relevant for hospital outpatient coders, compliance staff, and revenue cycle teams working with behavioral health-related outpatient services.

Why This Topic Matters

It helps readers understand which code families were introduced or addressed for this service category and how CMS framed their use under OPPS for Medicare payment purposes.

What You Will Learn

  • The CMS outpatient payment context for alcohol and substance abuse-related services
  • Which code families were discussed for CY 2008 reporting
  • How the article frames Medicare recognition and payment considerations for this service category
  • The general distinction CMS makes between screening-oriented and non-screening assessment/intervention services

Who Should Read This

  • Hospital outpatient coders
  • Outpatient reimbursement specialists
  • Revenue cycle staff
  • Compliance professionals
  • Behavioral health billing teams

Codes Discussed

  • CPT: 99408
  • CPT: 99409
  • HCPCS Level II: G0396
  • HCPCS Level II: G0397

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