Education & TrainingMedicaidJanuary 1, 2024

SBIRT Quick Reference Guide - Knowledge Saves - SBIRT Improving Lives Flier

SBIRT in action: improving patient lives

What is Screening, Brief Intervention, and Referral to Treatment (SBIRT)?

SBIRT is an evidence-based approach to identifying patients who use alcohol and other drugs at dangerous levels. The goal of SBIRT is to reduce and prevent related health consequences, disease, accidents, and injuries. Risky substance use is a health issue that often goes undetected; by incorporating this evidence-based tool demonstrated to be reliable in identifying individuals with risk for a substance use disorder, significant harm can be prevented.

SBIRT can be performed in a variety of settings. Screening does not have to be performed by a physician. SBIRT incorporates screening for all types of substance use with brief, tailored feedback, and advice. Simple feedback on risky behavior can be one of the most critical influences on changing patient behavior.

Why use SBIRT?

  • SBIRT is an effective tool for identifying risk behavioral and providing appropriate intervention.
  • By screening for high-risk behavior, care providers can use evidence-based brief interventions focusing on health and consequences, preventing future problems.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
  • SBIRT reduces costly healthcare utilization.
  • SBIRT is reimbursable through Medicaid.
  • SBIRT is appropriate for any patient, regardless of age, gender, or health status.

When we say…

We mean…

Screening

  • Provide a short, structured consultation to identify the right amount of treatment.
  • Use common screening tools such as AUDIT, ASSIST, DAST-10, CRAFFT and TWEAK.

Brief intervention

  • Educate patients and increase motivation to reduce risky behavior.
  • Brief education intervention increases motivation to reduce risky behavior.
  • Typically 5 to 10 minutes.

Brief treatment

  • Fulfill goals of:
    • Changing the immediate behavior or thoughts about a risky behavior.
    • Addressing longstanding problems with harmful drinking and drug misuse.
    • Helping patients with higher levels of disorder obtain more long-term care.
  • Typically 5 to 12 minutes.

Referral to treatment

  • If a patient meets the diagnostic criteria for substance dependence or other mental illnesses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, we recommend you refer them to a specialty care provider.

Who delivers SBIRT services?

Primary care centers, hospital emergency rooms, trauma centers and community health settings have the best chance to intervene early with at-risk substance users and prevent more severe consequences. Primary care providers are the primary source of SBIRT services; however, nurse practitioners, physician assistants and behavioral health providers play an important role as well. SBIRT services are intended to be delivered in primary care medical settings as the first line of substance use harm reduction, identification, and referral to specialized services.

SBIRT process flow

Implementing SBIRT into care management

There are multiple screening tools to use for different populations. Anthem Blue Cross recommends the following screening tools for their brief nature, ease of use, flexibility for multiple types of patients, and indication of need for further assessment or intervention:

Screening tool

Age range or population

Overview

Alcohol Use Disorder Identification Test (AUDIT)

All patients

Developed by the WHO, and appropriate for all ages, genders, and cultures.

Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST)

Adults

Simple screener for hazardous use of substances (including alcohol, tobacco, other drugs).

Drug Abuse Screening Test (DAST-10)

Adults

Screener for drug involvement, does not include alcohol, during last the 12 months.

Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)

Adolescents and children

Alcohol and drug screening tool for patients under 21. Recommended by American Academy of Pediatrics.

Screening to Brief Intervention (S2BI)

Adolescents

Assesses frequency of alcohol and substance

NIAAA Alcohol Screening for Youth

Pregnant women

Four-item scale to assess alcohol use in pregnant women; recommended for OB/GYNs.

Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE)

Pregnant women

Five item scale to screen for risky drinking during pregnancy.

Tolerance, Worried, Eye Opener, Amnesia, K/Cut Down (TWEAK)

Pregnant women

Five item scale to screen for risky drinking during pregnancy.

Getting reimbursed?

CPT® Code

Code description

99408

SBIRT: Alcohol and substance (other than tobacco) abuse structure screening (for example, AUDIT, DAST) and brief intervention (SBI) services; 15-30 minutes.

99409

SBIRT: Alcohol and substance (other than tobacco) abuse structure screening (for example, AUDIT, DAST) and brief intervention (SBI) services; over 30 minutes.

Need help with a referral to a behavioral health specialist?

Referrals can be complex and involve coordination across different types of services, and we can help. Call us at one of our Medi-Cal Customer Care Centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside L.A. County). We are glad to help you get our members this important kind of care.

Sources

1. Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare, 4/1/2019, SAMHSA.gov.

2. Alcohol Screening and Brief Intervention: A Guide for Public Health Practitioners, American Public Health Association, page 8.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: January 2024 Provider Newsletter