2025 HCPCS code G0397
(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) abuse structured assessment (e.g., AUDIT, DAST), and intervention; greater than 30 minutes.
Modifiers may be applicable depending on the circumstances of the service.Refer to the most current CPT and HCPCS modifier guidelines to ensure appropriate modifier application.
Medical necessity for G0397 is established by the presence of suspected or confirmed substance use disorder, based on a validated screening instrument. The intervention must be medically appropriate given the patient's substance use patterns and overall health status. Appropriate documentation demonstrating medical necessity is vital for successful reimbursement.
The clinical responsibility lies with a qualified healthcare professional (physician, nurse practitioner, or other licensed provider) capable of administering validated substance use assessments and conducting brief interventions.Accurate documentation of the assessment instrument used, the patient's score, the nature of the intervention, and the time spent are crucial.
In simple words: This code covers a doctor's appointment where they spend over 30 minutes checking for alcohol or drug problems (other than tobacco) and talking to the patient about it and creating a plan to help them.
This HCPCS code, G0397, represents the provision of alcohol and/or substance (excluding tobacco) abuse structured assessment and intervention services that extend beyond 30 minutes.The assessment utilizes a validated instrument (e.g., AUDIT, DAST) to evaluate the patient's substance use patterns. Following the assessment, a brief intervention is conducted, addressing the potential negative health and social consequences of continued substance misuse. The intervention typically involves discussing the frequency and quantity of substance use, exploring behavioral change strategies, and establishing action plans.The entire process, encompassing assessment and intervention, requires a minimum of 31 minutes of provider time.
Example 1: A patient presents to a primary care physician reporting concerns about alcohol consumption. The physician administers the AUDIT questionnaire, spends 45 minutes reviewing the results, discussing the negative impacts of alcohol abuse, and developing a personalized treatment plan including referral to a specialist., A counselor in a substance abuse treatment center conducts a DAST screening with a patient suspected of opioid misuse.The session, including assessment and intervention, lasts 50 minutes, focusing on harm reduction strategies and motivational interviewing techniques., A patient is seen in an urgent care setting after a motor vehicle accident.The physician notes the patient has slurred speech and suspects alcohol impairment.After administering the AUDIT and having a 35-minute discussion concerning the dangers of alcohol impairment and alcohol use disorder, the physician refers the patient to a treatment center.
* Detailed documentation of the assessment tool utilized (e.g., AUDIT, DAST).* Patient's score on the assessment instrument.* A comprehensive account of the intervention, including the topics discussed and strategies developed.* Total time spent on the assessment and intervention, which must exceed 30 minutes.* Referral information, if applicable.* The patient's response to the intervention.
** Always confirm payer-specific coverage policies before billing G0397, as coverage and reimbursement rates may differ significantly.Accurate coding and documentation are critical to ensure proper reimbursement and comply with regulatory requirements.
- RVU: The relative value units (RVUs) for this code will vary based on geographic location and payer.Consult your specific payer's fee schedule for the most accurate RVU information.RVUs are used to calculate Medicare reimbursement rates, but specific values are not readily available here.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to G0397 as this is a professional service code.
- Fee Schedule: Historical fee schedules for G0397 are not readily available here. Reimbursement amounts vary considerably by payer, location and year of service.Consult payer-specific fee schedules for past years' reimbursement data.
- Specialties:Primary Care, Addiction Medicine, Psychiatry, Social Work, Counseling
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Telehealth, Substance Abuse Treatment Center