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Enhanced Payments for SBIRT for Pregnant Members

Date: 01/30/25

Providers who complete a Screening, Brief Intervention, and Referral to Treatment (SBIRT) assessment are eligible for an additional $50 reimbursement per member, per screening. To learn more, visit Enhanced Payments for SBIRT Assessments.

Sunshine Health’s Enhanced Payment Program is in addition to the compensation arrangement in the participation agreement in our provider network, as well as other health plan incentive programs that providers participate in.

Who Is Eligible?

Primary care physicians (PCPs), including MDs and DOs; advanced practice nurses (APRNs); physician assistants (PAs); midwives; and obstetrician-gynecologists (OB/GYNs). The SBIRT model should also be used when treating members by behavioral health providers; physicians in primary care centers; hospital emergency rooms; trauma centers; and in other community medical settings.

Submit These Codes

Providers will earn $50 in addition to any billed Evaluation & Management (E&M) code.

  • H0049: Alcohol and/or drug screening.
  • H0050: Alcohol and/or drug services, brief intervention, per 15 minutes
  • 99408: 15–30 minute alcohol and/or substance abuse screening and brief intervention service
  • 99409: Structured alcohol and/or substance abuse screening and brief intervention services that last more than 30 minutes
  • G0396: Structured assessment and brief intervention for alcohol or substance abuse, other than tobacco; intervention must be 15 to 30 minutes long
  • G0397: Describes a structured assessment and intervention for alcohol and/or substance abuse that lasts more than 30 minutes

Deadline

  • Enhanced payments will be applied at the time of claim adjudication

For More Information

Live Virtual Training

Register for Sunshine Health’s live, virtual SBIRT training session on Wednesday, March 26, 2025.

  • Training is focused on screening and referral to treatment for alcohol and substance use for patients in a healthcare setting
  • Attendees will gain clinical knowledge and skills to implement SBIRT in their practice
  • Providers who complete the training will earn 2.5 training hours and 2 Continuing Education (CE) credits
  • Start time is 10 a.m. Eastern and training will last for 2½ hours

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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