Did you know?. At least one out of every 10 adults in the U.S. is affected by a substance use disorder, but just 11 percent of them get treatment.
Brief intervention in alcohol and substance misuse is an inevitable component of primary care in the face of shocking statistics. Luckily, providers can be paid to provide such services in the form of designated codes CPT 99408 and 99409. The only problem is: there are plenty of billing mistakes, and unless you know what you are doing, a great amount of money may go to waste under your watch.
In this article, we will help you tear down all that the providers, coders, and various billing teams should know about CPT 99408 and 99409, such as description, documentation, and reimbursement rates, as well as how to optimize revenue and guarantee compliance through a qualified Medical Billing Company.
What do you know about SBIRT?
The population health strategy known as SBIRT (Screening, Brief Intervention, and Referral to Treatment) is implemented through early intervention and screening techniques. It can help identify substance use disorders and those who are at risk of developing them, thereby reducing and preventing them. It has been simplified for use in primary care or family practice, hospital emergency rooms, and other community settings. By screening a large number of people, this offers the opportunity to take early action before things get worse.
The growing prevalence of substance use (and the opioid crisis) in the US is making it more and more clear that the SBIRT must be used in the clinical setting.
What is CPT Code 99408?
CPT code 99408 is applied to charge for a screening and brief intervention on the use of alcohol and/or a substance, and when the process takes between 15 and 30 minutes. Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., Brief intervention services (AUDIT, DAST) lasting 15 to 30 minutes.
It is the most common alcohol screening, CPT code, where a provider will offer time-based intervention because someone has reported a positive screen for an alcohol or drug misuse disorder.
What is CPT Code 99409?
In the case of taking intervention up to 30 minutes, CPT 99409 is charged. Short intervention programs (lasting more than 30 minutes), alcohol and/or substance (apart from tobacco) abuse substance screens (such as AUDIT, DAST).
Consider CPT 99409 a continuation of CPT 99408, as the former makes it up to the providers who end up giving more time to education, counseling, and treatment planning efforts.
How is 99408 different from 99409?
Both coding systems are used to bill for brief intervention treatments and screenings for alcohol and/or substance abuse (apart from tobacco) :
- The CPT code 99408 is for a 15–30 minute short intervention.
- For short-term therapies lasting longer than 30 minutes, CPT Code 99409 is used.
The time required to deliver the screening or assessment, evaluate the results, and provide the patient with counselling is included in the CPT 99408 and CPT 99409 time used.
How can I charge CPT 99408 or CPT 99409?
Adults who have a negative SBIRT cannot be billed because they will not receive any kind of intervention if the results are negative. The 15 minutes that the 99408 billing code requires cannot be used to charge time spent performing an E/M service. The following is the question you should ask yourself to determine if you are able to bill a 99408 :
- This 15–30 minute period is either extra time the provider spends with the patient to conduct the screening, assess, and communicate the results, or it is separate time from the time the provider spends providing the E/M service.
It is a real-life example of avoiding a crisis :
In Chicago, one of the family physicians saw a young patient of 28 years old as part of regular care. Hazardous drinking was identified by a well-organized screening with the AUDIT during the visit. The doctor used 25 minutes to discuss risks with the patient, to provide motivational interviewing, and to work out a follow-up plan.
Billing Breakdown:
- Service delivered: Alcohol brief intervention
- Time: 25 minutes
- Charged code: 99408
A proper record of time, screening tool applied, and intervention carried out resulted in quick and full reimbursement.
Some Tools that are Common in Alcohol/Substance Screening :
A validated screening instrument has to be documented to bill CPT 99408 or 99409. Common examples:
- Event AUDIT (Alcohol Use Disorders Identification Test)
- DAST ( Drug Abuse Screening Test )
- Alcohol, Smoking, and Substance Involvement Screening Test, Assist.
Such tools work in accordance with the 99408 CPT description and correspond to the payer’s expectations of a structured screening.
Brief interventions like those billed under CPT 99408 and 99409 are often part of comprehensive care strategies. For example, in patients dealing with chronic pain conditions such as lumbar spondylolisthesis (M43.16), substance use screenings can support safer pain management plans.
Some Related Codes
| CPT Codes | Description |
| 96127 | Emotional/behavioral screening emphatic rating (e.g., PHQ-9) |
| 99406 | The smoking cessation counseling (3- 10 minutes) |
| 99407 | Cessation (smoking in excess) of more than 10 minutes |
| G0396/G0397 | Equivalents of 99408 and 99409 Medicare |
| 99401–99404 | Preventionist counseling services |
In case of billing, a tobacco counseling diagnosis code should be smoking cessation, like F17.200 with 99406 and 99407.
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Common Mistakes to Avoid
- Wrong time recording (requires 15 15-minute mark to qualify 99408)
- A failure to specify the screening tool
- Billing of an inappropriate diagnosis code
- Tobacco use (use 99406/99407 instead) (99408)
- Billings overlapped with E/M services (need to be distinguishable on their own)
Conclusion
Brief interventions are an evidence-based and reimbursable solution in times when the scope of mental health and substance use is increasing. CPT 99408 and 99409 assist providers with responding to substance use in a procedural and chargeable manner. However, to ensure maximum billing and keep within compliance regulations, documentation, timing, and coding requirements must be comprehended by billing teams.
FAQS
Q: Does CPT 99408 take place during tobacco counseling?
No. Code 99406 or 99407 as tobacco use. CPT 99408 is alcohol or other substances only, and not tobacco.
Q: Are these codes used with telehealth?
Yes, that is, 99408 or 99409 both apply to reimburse telehealth services relative to payer policy. Modifier 95 should be used where appropriate.
Q: Am I able to bill the 99408 using a preventive visit?
Yes, but it must be able to document a separate, distinct service and be able to qualify within the 15-minute requirement.
