2025 CPT code 99409
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Preventive Medicine Services - Counseling, Risk Factor Reduction and Behavior Change Intervention Evaluation and Management Feed
Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes.
Modifier 25 is required when reporting this code with other EM services on the same day to indicate a significant, separately identifiable service.
Medical necessity for 99409 is established when a patient presents with risk factors or behaviors suggestive of alcohol or substance abuse (excluding tobacco) and requires a structured screening and brief intervention. The intervention should be tailored to the individual's needs, promoting harm reduction and facilitating behavior modification. Documentation must clearly establish the medical necessity.
The clinical responsibility involves administering a validated substance abuse screening test (e.g., AUDIT, DAST), interpreting the results, and providing individualized brief intervention counseling focused on behavior modification and harm reduction strategies.Documentation of the screening tool used and the details of the intervention are crucial.
In simple words: This code covers a doctor's visit where they spend more than 30 minutes screening you for alcohol or drug abuse (excluding tobacco) and then giving you advice and support on how to change your habits if needed. They use special tests to assess your substance use and will talk about the risks of continuing the behavior and help you develop a plan to address it.
This CPT code, 99409, represents the provision of alcohol and/or substance (excluding tobacco) abuse structured screening services, along with brief intervention services.The screening utilizes validated instruments such as the AUDIT (Alcohol Use Disorders Identification Test) or DAST (Drug Abuse Screening Test).The brief intervention, guided by the screening results, involves counseling on the negative health and social consequences of substance abuse, exploration of usage patterns, discussion of behavior change strategies, and development of action plans. The total time spent on screening and intervention exceeds 30 minutes.This code should not be reported with 99408 on the same day.If used with other E/M services on the same day, modifier 25 is required.
Example 1: A patient presents for a routine physical exam.During the visit, the physician administers an AUDIT screening test. The results indicate potential alcohol abuse, and the physician spends 45 minutes discussing the risks of alcohol misuse, strategies for reducing alcohol consumption, and setting goals for behavior change. Code 99409 is reported, along with the appropriate preventive medicine code and modifier 25 if additional E/M services are performed., A patient is referred to a substance abuse counselor after a positive drug screening. The counselor conducts a DAST screening and spends an hour in a brief intervention session, addressing the patient's substance use patterns, discussing potential consequences, and collaborating on a plan to reduce substance use. Code 99409 is appropriately reported., A patient presents to the emergency department with injuries related to a suspected alcohol-related incident. After stabilizing the patient, the physician performs an AUDIT screening and initiates a brief intervention, recommending treatment and resources. Code 99409 is reported, along with the appropriate emergency department E/M code and modifier 25.
* Detailed documentation of the screening instrument used (e.g., AUDIT, DAST).* Complete recording of the screening results.* Comprehensive documentation of the brief intervention provided, including the topics discussed, strategies suggested, goals set, and agreed-upon action plans.* Time spent on screening and intervention (must exceed 30 minutes).* Any referrals made for treatment.
** This code is specifically for alcohol and/or substance abuse screening and brief intervention. It does not include referral to treatment, which may be reported separately.Time spent on the service must exceed 30 minutes to justify the use of this code. Payers may have specific requirements and limitations regarding reimbursement for this code.
- Revenue Code: M5D (Specialist - Other)
- RVU: The relative value units (RVUs) for this code will vary depending on geographic location and payer.The addition of 99409 to other EM services may increase the overall RVUs of the encounter, and modifier 25 is required to reflect the separately identifiable service.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and geographic location.Consult current fee schedules for specific reimbursement rates.
- Specialties:Addiction Medicine, Psychiatry, Family Medicine, Internal Medicine
- Place of Service:Office, Outpatient Hospital, Emergency Room, Inpatient Hospital, Telehealth (depending on payer and circumstances)