Governor's Policy Subcommittee on SBIRT Billing and Reimbursement (Charter)

Justification
One key to the sustainability of SBIRT service delivery is billing and reimbursement for services.

Description
In SBIRT grant year 2 (fall 2007 through summer 2008), billing codes to reimburse for screening and brief intervention were published by Medicare, Medicaid and CPT. The SBIRT project will need assistance in overcoming barriers to utilizing the billing codes. WIPHL sites will need guidance and technical assistance as they operationalize billing for screening and brief intervention.

Goals/Objectives
1. Outline the policies and procedures for using HCPCS codes for WIPHL clinics.
2. Outline the policies and procedures for using CPT codes for SBI services at WIPHL clinics.
3. Outline the policies and procedures for using G codes for SBI services at WIPHL clinics.
4. Provide guidance to clinics to overcome barriers around billing and reimbursement for screening and brief intervention.

Measurement of Success
1. 75% of eligible clinics will report that they have administrative and clinical systems in place to bill for SBI services.
2. 75% of eligible clinics will bill Medicare and Medicaid patients for SBI services.

Deliverables
WIPHL and the subcommittee will:
1. Prepare written guidance about using HCPCS codes and CPT and G codes.
2. Distribute written guidance to all participating WIPHL clinics.
3. Provide input to the development of educational materials and forums for education about SBI billing and reimbursement.
4. Guide provision of technical assistance about CPT and HCPCS, and G code use.

Issues and Constraints
1. DHFS and the WIPHL Coordinating Center will continue to work with SAMHSA to get clarification on the definitions for HCPCS codes so that they can be utilized.
2. The WIPHL Coordinating Center will continue to work with clinics on documentation and record keeping, in both paper and electronic medical records, to meet billing and reimbursement requirements.

Click here for a pdf of the above charter in more detail.