1. SBIRT: Screening, Brief Intervention, Referral to Treatment
Stephen Ferrante, M.S.W.
Group Victory Managing Partner
Barry University School of Social Work Professor
September 27, 2013

3. Substance Abuse Severity and Level of Care
Adapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990)
None
Substance Abuse Severity
Mild
Moderate
Severe
Specialized
Treatment
Brief
Intervention
Primary
Prevention

4. SBIRT Core Components

5. SBIRT Approach National Evidence-based Initiative for Screening, Brief Intervention, and Referral to Treatment
Engagement
Pre-Screening: Risk Identification
Screening & Assessment: Risk Intensity
Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services
Discharge with Outcome Screening
Follow-up Screens

6. SBIRT Process Universal Prescreening
Symptoms Identification Difficult
Minimal Self-Referral
Full Assessment for Positive Prescreen
Level of Risk dictates Service Type:
Screening & Feedback (SF) for negative screens
Brief Intervention (BI) for moderate risk
Brief Treatment (BT) for moderate to high risk
Referral to Treatment (RT) - high risk/problem use

7. Prescreen: Part I

8. Prescreen: Part II

9. Interview Style Screen Administered for Positive Prescreen
Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) World Health Organization (WHO)
Interview Style Screen Administered for Positive Prescreen
ASSIST developed to help healthcare professionals detect and manage substance use
Scores provide a “level of risk” for substance misuse and type of service that follows:
Low risk = Screening & Feedback about results
Moderate risk = indicates the need for Brief Intervention
Moderate to High Risk = Brief Treatment
High Risk = Referral to Treatment

10. Motivational Interviewing Therapeutic Alliance
People who “Screen Positive” for Substance Misuse
May be reluctant to seek help
May be ambivalent about decision to change behavior
Confrontation & Labeling may Produce “Resistance” and/or “in Denial”
Avoiding Labeling & Confrontation
Roll with Resistance
Enhance Self-Efficacy
Build Confidence in One’s Coping Strategies

11. Motivational Interviewing
Acknowledging Motivation, Readiness & Ability for Change
Meeting Individuals Where They are
Respectful Listening
Accepting Individual’s Perspective
Identifying Consequences of Problem
Facilitating Perception Shift on Impact of Problem
Empowering Individual to Generate Insights & Solutions
Expressing Belief in Person’s Capacity to Change
Offsetting Denial, Resentment & Shame

12. Early SBIRT Examples Emergency Departments
Bernstein E, Bernstein J, Levenson S: Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med , 1997; 30:
Primary Care Practices as “Brief Physician Advice”
Fleming, MF., Manwell, LB, Barry, KL, Adams, W, & Stauffacher, EA Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J Fam Pract; (5):

13. SBIRT Today Emergency Departments Hospital Units
Primary Care Practices
Urgent Care
Federally Qualified Health Center
Health & Behavioral Health Clinic
Addiction Facilities
Educational Institutions
Community Service Settings

14. Health Care Providers can Provide SBIRT Services under Medicare
Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals
Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT
To bill Medicare, providers of MH services must be:
Licensed or certified to perform mental health services by the state in which they perform the services;
Qualified to perform the specific mental health services rendered; and
Working within their State Scope of Practice Act

15. SBIRT Billing & Reimbursement
Affordable Care Act Recommended Service
Screening & Brief Intervention Reimbursement
Commercial insurance CPT codes
Medicare G codes
Medicaid HCPCS codes
Florida has not approved Medicaid Billing Codes
SAMHSA Block & SBIRT Grants

16. SBIRT Coding http://sbirt.samhsa.gov/coding.htm
Payer
Code
Description
Fee Schedule
Commercial
Insurance
CPT 99408
Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
$33.41
CPT 99409
Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
$65.51
Medicare
G0396
$29.42
G0397
$57.69
Medicaid
H0049
Alcohol and/or drug screening
$24.00
H0050
Alcohol and/or drug service, brief intervention, per 15 minutes
$48.00

17. Common Behavioral Health Codes
CPT Code
Description
90801
Diagnostic interview
90804
Individual psychotherapy, 20‒30 minutes
90806
Individual psychotherapy, 45‒50 minutes

20. A 16-session curriculum manual for conducting brief treatment
The Result:
A 16-session curriculum manual for conducting brief treatment
(Dupree & Schonfeld, CSAT, 2005)

21. Questions Answers Comments Thank You!