The following tables list the HCPCS procedure codes and applicable diagnosis codes that providers are required to use when submitting claims for substance abuse screening and substance abuse intervention services under the SBIRT benefit.
| Place of Service Codes (Submitted on the 1500 Health Insurance Claim Form) |
|
|---|---|
| 03 | School |
| 11 | Office |
| 12 | Home |
| 19 | Off Campus — Outpatient Hospital |
| 21 | Inpatient Hospital |
| 22 | On Campus — Outpatient Hospital | 23 | Emergency Room — Hospital |
| 99 | Other Place of Service |
| Substance Abuse Screening and Intervention Services | |||||
|---|---|---|---|---|---|
| Procedure Code | Description | Limitations (Medicaid and BadgerCare Plus) | Allowable Place of Service | Allowable Diagnosis Code | |
| H0049 | Alcohol and/or drug screening | Limited to one unit per member, per rolling 12 months. | 03, 11, 12, 19, 21, 22, 23, 99 | Z13.9 (Encounter for screening, unspecified) | |
| H0050 | Alcohol and/or drug service, brief intervention, per 15 minutes | Limited to 16 units per member, per rolling 12 months. | 03, 11, 12, 19, 21, 22, 23, 99 | Z71.89 (Other specified counseling) | |