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March 27, 2018

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Coverage Limited for Alcohol and Substance Abuse Assessment and Intervention

December 11, 2007:
The Centers for Medicare and Medicaid Services (CMS) will not recognize new CPT® codes 99408 and 99409 for reporting alcohol and/or substance abuse screening. Medicare does not cover screening services unless specifically mandated by statute, such as has been done for mammography, diabetes, and colorectal cancer screening.

These CPT® codes will not be paid under the 2008 Medicare physician fee schedule (MPFS) or the outpatient prospective payment system (OPPS); they have been assigned status indicator N or E, respectively.

However, CMS has created two parallel G codes for reporting alcohol and substance abuse assessment and intervention services not provided as screening services but performed to diagnose or treat illness or injury. The codes are HCPCS Level II codes G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes; and G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and intervention, greater than 30 minutes. These G codes are active in both payment systems. Medicare contractors will pay for these codes only when considered reasonable and necessary.

CPT is a registered trademark of the American Medical Association.

Regina Magnani, RHIT
Clinical/Technical Editor


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