Screening, Brief Intervention, Referral to Treatment (SBIRT) Benefit

Health First Colorado covers SBIRT services in primary care, hospital, and emergency room settings.

SBIRT is designed to prevent members from developing a substance use disorder, for early detection of a suspected substance use disorder, or to refer members for treatment. These services are not intended to treat members already diagnosed with a substance use disorder or those members already receiving substance use disorder treatment services. Members who are pregnant may be eligible for additional substance use screening and intervention services through Special Connections, Outpatient Substance Use Disorder treatment, and the Prenatal Plus program.

Treatment referrals must be made to the member's Regional Accountable Entity (RAE). Please visit the RAE web page for contact information and further details.

Who is eligible for SBIRT services?

All enrolled members ages 12+ are eligible to receive these services.

Reference the billing and policy manual for complete details.

What services are available?

A variety of CPT billing codes are available for billing. These include but are not limited to:

  • Full screening (whether positive or negative)
  • Full screening + brief intervention

 

Reference the billing and policy manual for complete details.

Eligible Providers

The following licensed providers are eligible to provide SBIRT or supervise staff who provide SBIRT: Physician/psychiatrist, Psychologist, PsyD / Ph.D., Licensed clinical social worker (LSCW), Licensed marriage and family therapist (LMFT), Licensed professional counselor (LPC), Nurse Practitioner, Physician Assistant.

In order to directly deliver screening and intervention services, providers are required to participate in training that provides information about the implementation of evidence-based protocols for screening, brief interventions, and referrals to treatment.

Reference the billing and policy manual for complete details.

How do I become an enrolled provider?

As a Health First Colorado (Colorado's Medicaid Program) provider, you have the opportunity to improve the health and well-being of more than a million Coloradans. Health First Colorado is more than health insurance - it is a vital public service, helping almost one in five Colorado citizens stay healthy or move towards better health.

The enrollment process is online and begins on the Provider Enrollment web page.

Enrollment in Managed Care networks is only required if the member being treated is in the Denver Health or Rocky Mountain Health Plan networks.

General Policies

  • All services must be medically necessary.
  • All claims must include the National Provider Identification (NPI) number of the enrolled provider who rendered the service.
  • All claims must include the NPI number of the enrolled provider who ordered the service if rendered by a non-physician.
  • Co-pays may be applicable to this benefit if it is billed in conjunction with CPTs that have co-pays. If only the SBIRT CPTs are billed, there are no co-pays. Co-pays are only required if the member is not a child (under age 19) or a pregnant woman. Other exceptions may apply.

Reference the billing and policy manual for complete details.

How are services reimbursed?

SBIRT services are reimbursed according to the current Health First Colorado Fee Schedule. Reimbursement rates will vary by CPT code reported. The fee schedule shows the maximum allowed reimbursement for each CPT code. Submitted claims will be reimbursed according to "lesser-of" pricing logic. This means that the line item will reimburse either at submitted charges or the fee schedule rate, whichever is lesser.

Providers must first enroll in the program to submit claims. Once they are enrolled, providers may submit claims directly by logging into the Provider Web Portal. Claims may be submitted by billing agencies on behalf of the provider.

Resources for enrollment and billing may be found at Provider Resources.

Recent News and Updates

  • Check the Provider Bulletin index for all provider bulletins related to the SBIRT benefit.
  • National Correct Coding Initiative (NCCI) billing edits affect this benefit. Providers should be familiar with the information found on the Medicaid.gov NCCI Website, including the NCCI Policy Manual found there.

Provider Training Available

Health First Colorado contracts with Peer Assistance Services INC to provide free in-person and online SBIRT training and technical assistance to health care professionals.

Visit their training website for details.

Policy Documents

Applicable Rules, Regulations, and Statutes

All Medicaid Rules, Regulations, and Statutes apply to the administration of the Colorado Medical Assistance Program at large, which providers are required to follow. The following are specifically called out as the ones governing the SBIRT benefit:

  • 42 CFR 440.130 - Federal regulation describing the minimum requirements for a State Medicaid Agency to cover SBIRT.

Contact Information

  • Questions about claims and billing must be directed to the fiscal agent. A list of resources is available on the Provider Contact web page.
  • Questions about policy and coverage may be directed to the program administrator. Contact Alex Weichselbaum at Alex.Weichselbaum@state.co.us