Reimbursement policies that enable systematic service delivery conform to the following criteria:
- Tobacco, alcohol and drug screening and intervention services are reimbursed under CPT codes 99406, 99407, 99408, and 99409, or Medicare G-codes G0396 and G0397, or Medicaid H-codes H0049 and H0050.
- Credentialed providers may be reimbursed when they supervise paraprofessionals in delivering these services. Rationale: Most providers lack the time to deliver evidence-based services to most patients who would benefit. Services must be delivered in the most cost-effective manner possible and paraprofessionals have been shown to deliver effective services in many healthcare settings throughout Wisconsin and the U.S.
- The services are reimbursed when a paraprofessional delivers these services and the other providers deliver other professional services at the same visit. Rationale: Most patients will not make a separate visit for initial screening and intervention.
- The patient does not incur any out-of-pocket charges for these services. Rationale: Most patients decline BSI services if they will have to pay even a small amount.
Insurers: What You Can Do to Help
- Reimburse for behavioral screening and intervention services as we’ve outlined in Effective Reimbursement
- Let us know when you have reimbursements in place. We’d like to publicize your good work. Setting a visible example will help move other insurers toward effective reimbursement policies