2025 HCPCS code G0396
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Substance Abuse Assessment and Intervention Alcohol and Substance Abuse Assessments Feed
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., AUDIT, DAST), and brief intervention, 15 to 30 minutes.
Modifiers may be applicable depending on the circumstances of service. Consult the latest CPT and HCPCS modifier guidelines.
Medical necessity is established when the patient presents with symptoms or behaviors suggestive of alcohol or substance misuse requiring assessment and intervention.This might include elevated AUDIT/DAST scores, self-reported substance use issues, or symptoms that are clinically concerning. The intervention should be medically appropriate given the patient's assessed level of risk and needs.
The clinical responsibility lies with a licensed healthcare professional qualified to perform substance abuse assessments and interventions.This could include physicians, nurse practitioners, physician assistants, or other licensed clinicians, depending on state regulations.
In simple words: This code covers a doctor's visit where they use a special test to check for alcohol or drug misuse (not tobacco).The visit includes a short talk about the problems caused by substance use and creating a plan for change. The whole visit takes 15 to 30 minutes.
This HCPCS code represents a structured assessment for alcohol and/or substance (excluding tobacco) misuse, using validated instruments like the AUDIT (Alcohol Use Disorders Identification Test) or DAST (Drug Abuse Screening Test), followed by a brief intervention.The assessment and intervention together should take between 15 and 30 minutes.Documentation should include the specific instrument used, the results of the assessment, and a detailed description of the brief intervention provided.
Example 1: A patient presents to their primary care physician with concerns about their alcohol consumption. The physician administers the AUDIT, identifies a problem, and conducts a brief intervention to discuss reducing alcohol use and explore resources., An individual is referred to a substance abuse counselor after a positive drug screen. The counselor uses the DAST, identifies problematic drug use, and provides a brief intervention focused on harm reduction strategies and treatment options., A patient in an emergency room after a motor vehicle accident tests positive for opioid use.The emergency physician performs an assessment and initiates a brief intervention regarding safe opioid use and referral to addiction treatment.
* Patient demographics and relevant history.* Type of assessment instrument used (e.g., AUDIT, DAST).* Assessment results and scoring.* Documentation of the brief intervention provided, including specific strategies and treatment planning.* Any referrals made.* Signatures and dates.
** This code is typically used for services provided to Medicare beneficiaries.Check payer-specific policies and coverage criteria to determine if this code is acceptable for other payers.
- RVU: The RVUs for this code vary depending on the payer and geographic location.Consult the specific payer's fee schedule for accurate values.
- Payment Status: Active, but reimbursement depends on payer policies and medical necessity.
- Modifier TC rule: A Technical Component (TC) modifier is generally not applicable to this professional service code.
- Fee Schedule: Fee schedules vary by payer and location. Consult current fee schedules for the most accurate information.
- Specialties:Primary Care, Addiction Medicine, Psychiatry, Family Medicine, Internal Medicine
- Place of Service:Office, Hospital, Urgent Care, Telehealth