CPT 99408 / CPT 99409 Billing and Usage Guide
NOTE: 99408 and 99409 are no longer covered by most insurances. See our Article on CPT codes 96136, 96138, and 96130.
What is SBIRT?
SBIRT (Screening, Brief Intervention, and Referral to Treatment) is a public health approach to screening and early intervention to help identify, reduce, and prevent substance use disorders and people at risk for developing substance use disorders. It has been adapted for use in family practice & primary care settings, hospital emergency settings as well as other community settings. Screening large numbers of individuals offers the possibility for early intervention, before more severe consequences occur.
The importance of integrating SBIRT into the clinical setting is becoming increasingly important due to widespread substance use (and the Opioid crisis) in the United States. According to the 2016 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA 20016), “an estimated 1.5 percent of adults aged 18 or older in 2016 (3.6 million adults) received any substance use treatment in the past year, and 0.9 percent (2.1 million adults) received treatment at a specialty facility…” See the full survey here.
What is the difference between CPT code 99408 and 99409?
Both CPT codes are for billing alcohol and/or substance abuse (other than tobacco) screening and brief intervention services:
· CPT code 99408 is for brief intervention between 15-30 minutes
· CPT Code 99409 is for brief interventions greater than 30 minutes.
The time for CPT 99408 and CPT 99409 includes the time spent both administering the screening/ assessment and the time spent reviewing the results, and counseling the patient.
When can I bill for CPT Code 99408 or CPT 99409?
You cannot bill for a negative SBIRT on adults because there is no intervention when the results are negative. Time spent performing an E/M service cannot be counted toward the 15-minute minimum for 99408. To determine whether you can bill for 99408, consider the following question:
Does the 15-30 minutes include the time spent on the E/M service OR is the time spent with the patient an additional 15-30 minutes to administer the screening, review, and discuss the results with the patient?
When do I use modifier 59 with CPT 99408 or CPT 99409?
Each insurance is different. Some insurance require modifier 59 and others modifier 25.
Please check with each insurance provider for specific guidelines.
Under certain circumstances, a physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician.
NOTE: Modifier 25 should be appended to the E/M and modifier 59 should be appended to the 99408/ 99409 CPT code.