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SBIRT Credentialing and Billing — Updated

Since September 1, 2011, the settings in which Screening, Brief Intervention and Referral to Treatment (SBIRT) services have expanded to include primary care settings and also reimbursement for primary care physicians and physician extenders (e.g., physician assistants and nurse practitioners and midwives) who conduct SBIRT for Medicaid managed care and Family Health Plus (FHPlus) members 10 years and older.

SBIRT is a screening and referral program designed to identify individuals at risk for substance use issues and provide early intervention to prevent the development of serious substance abuse. Members whose SBIRT screening identifies them as needing treatment from a substance abuse professional should be referred to an Emblem Behavioral Health Services practitioner. Receipt of SBIRT services does not preclude Medicaid managed care and FHPlus members from self-referring for one chemical dependence assessment in any calendar year.

Credentialing SBIRT Practitioners
To render SBIRT services under this benefit expansion, you must be a PCP or PCP extender and certified by the American Society of Addiction Medicine (ASAM), the American Board of Ambulatory Medicine (ABAM), the American Academy of Addiction Psychiatry (AAAP) or the American Academy Osteopathic Association (AOA), or have completed an Office of Alcoholism and Substance Abuse Services (OASAS)-approved SBIRT training of at least four hours. Learn more about available OASAS resources, screening tools and training.

EmblemHealth will credential practitioners as having the above certification or training. To be credentialed for this expertise, practitioners must:

• Be a credentialed participating PCP or a physician assistant, nurse practitioner or midwife, psychologist, licensed master social worker, licensed clinical social worker or licensed mental health counselor working in conjunction with a credentialed participating PCP.
• Request to be credentialed in SBIRT services.
• Submit proof of the required certification or training.

EmblemHealth practitioners may forward requests and proof of certification or training by fax to 1-212-510-5268. The Credentialing department will process the practitioner for Credentialing Committee approval.

Emblem Behavioral Health Services practitioners participating with ValueOptions may forward requests for credentialing and proof of certification or training to ValueOptions for approval by fax to 1-866-612-7784. Practitioners not participating with ValueOptions must submit a credentialing application in addition to proof of SBIRT certification or training.

Note that claims for SBIRT services will be denied if the service provider is not credentialed for SBIRT services.

Billing Guidelines
SBIRT services may be billed using the following HCPCS procedure and diagnosis codes:

• H0049 (alcohol and/or drug screening) for substance use screening.
  Diagnosis code V82.9 (unspecified condition) — required on claims for procedure code H0049. Medicaid and FHPlus members are limited to two H0049 services per calendar year.
• H0050 (alcohol and/or drug service, brief intervention) for substance use brief intervention services.
  Diagnosis code V65.42 (counseling on substance use and abuse) — required on claims using procedure code H0050. Medicaid and FHPlus members are limited to six H0050 services per calendar year.

SBIRT services are not subject to the FHPlus calendar-year benefit limit for behavioral health services or FHPlus copayments. New York State Department of Health regulations prohibit managed-care plans from prior approving SBIRT services. As a result, we cannot advise practitioners whether the member has exceeded the limit prior to service delivery. However, EmblemHealth will not pay claims that exceed the member's benefit limits.

Reimbursement Rates
EmblemHealth will reimburse practitioners for SBIRT services rendered to Medicaid members without regard to the SSI status of the member or the nature of the visit. SBIRT services will be reimbursed in accordance with your Provider Agreement.

For questions about SBIRT services, contact us at 1-866-447-9717, option 5. Or you may use the Message Center by signing in to our Web site. For behavioral health questions related to SBIRT services, please contact ValueOptions at 1-800-235-3149.