Alcohol Misuse Screening and Counseling
SABIRT includes alcohol and drug misuse screening, assessment, brief interventions and referral to treatment for Medi-Cal Managed Plan (MMP) members ages 11 and older, including pregnant women.
Why SABIRT?
The American Academy of Pediatrics (AAP) Bright Futures initiative recommends tobacco, alcohol, and drug use screening and assessment with appropriate follow-up action as necessary, beginning at age 11. Additionally, the United States Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in primary care settings in adults 18 years of age and older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.
Who made SABIRT a requirement and when did it start?
The Department of Health Care Services (DHCS) released All Plan Letter (APL) 21-014 on October 11, 2021, which outlines the requirement for SABIRT services. APL 21-014 supersedes APL 18-014, which noted required services for Alcohol Misuse Screening and Counseling (AMSC).
How will I be reimbursed for this?
Blue Shield Promise will process your claim through its normal channels for claim reimbursement. The following HCPCS codes may be used to bill for SABIRT services as outpatient services only:
| HPCPS code | Description | When to Use | Frequency Limit | Notes |
|---|---|---|---|---|
| G0442 | Annual alcohol misuse screening, 15 minutes | Alcohol use screening | 1 per year, per provider | The minimum age has changed from 18 to age 11. |
| H0049 | Alcohol and/or drug screening | Drug use screening | 1 per year, per provider | |
| H0050 | Alcohol and/or drug services, brief intervention, per 15 minutes | Alcohol misuse counseling or counseling regarding the need for further evaluation/treatment | 1 per day, per provider | Brief intervention services may be provided on the same date of services as the alcohol or drug use screen, or on subsequent days. |
Please note that HCPCS codes H0049 and H0050 are reimbursable “by report.” An attachment documenting the services delivered must be submitted with claims for H0049 and H0050. For more information, visit the Evaluation & Management (E&M) section of the Medi-Cal Provider Manual.
For whom do I administer SABIRT?
Blue Shield Promise Medi-Cal members who are ages 11 and older, including pregnant women.
How do I administer SABIRT?
Blue Shield Promise members 11 years of age and older must be screened for alcohol and drug misuse once annually in primary care settings. Providers must document in the member’s medical chart that SABIRT was administered.
Screening
Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:
- Cut Down, Annoyed, Guilty, Eye-Opener Adapted to Include Drugs (CAGE-AID)
- Tobacco, Alcohol, Prescription medication, and other Substances (TAPS)
- National Institute on Drug Abuse (NIDA) Quick Screen for adults
- The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening.
- Drug Abuse Screening Test (DAST-10)
- Alcohol Use Disorders Identification Test (AUDIT-C)
- Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
- Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
- Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population
Brief Assessment
When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or substance use disorder (AUD or SUD) is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools.
Validated assessment tools include, but are not limited to:
- NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
- Drug Abuse Screening Test (DAST-20)
- Alcohol Use Disorders Identification Test (AUDIT)
Brief Interventions and Referral to Treatment
For members with brief assessments that reveal unhealthy alcohol use, brief misuse counseling should be offered. Appropriate referral for additional evaluation and treatment, including medications for addiction treatment, must be offered to recipients whose brief assessment demonstrates probable AUD or SUD.
Alcohol and/or drug brief interventions include alcohol misuse counseling and counseling a member regarding additional treatment options, referrals, or services. Brief interventions must include:
- Providing feedback to the patient regarding screening and assessment results
- Discussing negative consequences that have occurred and the overall severity of the problem
- Supporting the member in making behavioral changes
- Discussing and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated
Documentation Requirements
Member medical records must include:
- The service provided (e.g., screen and brief intervention)
- The name of the screening tool and the score (unless the screening tool is embedded in the electronic health record)
- The name of the assessment instrument (when indicated) and the score on the assessment (unless the screening tool is embedded in the electronic health record)
- If and where a referral to an AUD or SUD program was made
How often can I administer SABIRT?
Consistent with AAP and USPSTF recommendations, providers must annually screen adult and child members 11 years of age and older for alcohol and drug misuse. Although Blue Shield Promise will reimburse providers only for once-annual alcohol and drug misuse screenings, additional screenings must be provided when medically necessary. Medical necessity must be documented by the member’s PCP or primary care team.
What tool do I use for screening?
Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:
- Cut Down, Annoyed, Guilty, Eye-Opener Adapted to Include Drugs (CAGE-AID)
- Tobacco, Alcohol, Prescription medication, and other Substances (TAPS)
- National Institute on Drug Abuse (NIDA) Quick Screen for adults
- The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening
- Drug Abuse Screening Test (DAST-10)
- Alcohol Use Disorders Identification Test (AUDIT-C)
- Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
- Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
- Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population
When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or SUD is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools. Validated assessment tools include, but are not limited to:
- NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
- Drug Abuse Screening Test (DAST-20)
- Alcohol Use Disorders Identification Test (AUDIT)
What if the member needs something more?
As needed, providers can and should refer members to the substance use disorder (SUD) treatment services in the county where the member lives. To make referrals, explore directories of SUD services in your area, or contact the SUD Resource Center at (800) 879-2772.
Where do I go for more information?
If you have questions, contact Blue Shield Promise’s Behavioral Health Department: PromiseBehavioralHealth@blueshieldca.com
Reference materials
Resources
Provider resources for brief interventions include:
- Brief Negotiated Interview (BNI)
- The Substance Abuse and Mental Health Services Administration (SAMHSA) website
Referrals
- SUD Directories
- Members requiring treatment for SUD will receive services through their county of residence (Los Angeles or San Diego). For further assistance with SUD referrals, you may contact:
- San Diego Access & Crisis Line: (888) 724-7240
- Los Angeles County Substance Abuse Service Helpline (SASH): (844) 804-7500
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