Medicare pays for opioid use disorder (OUD) screenings performed by physicians and non-physician practitioners. If you diagnose your patient with OUD, they also pay for treatment services.
When Can I Screen My Patients for OUD?
- During required screening elements of Medicare's Initial Preventive Physical Exam (IPPE) and Annual Wellness Visit (AWV).
- During visits in physician's offices and outpatient hospital settings to screen people who may not seek substance use help. In these cases, you can offer Screening, Brief Intervention, & Referral to Treatment (SBIRT) treatment services.
How Do I Bill for These Screenings?
| Service | HCPCS Code | Things to Know |
| IPPE | G0402 | You're required to screen for OUD as part of the IPPE |
| Initial AWV | G0438 | You're required to screen for OUD as part of the AWV |
| Subsequent AWVs | G0439 | You're required to screen for OUD as part of subsequent AWVs |
| SBIRT | G2011 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., AUDIT, DAST) and brief intervention 5-14 minutes |
| SBIRT | G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., AUDIT, DAST) and brief intervention 15-30 minutes |
| SBIRT | G0397 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., AUDIT, DAST) and brief intervention greater than 30 minutes |
Click here if you want to learn more about treatment options for OUD, E/M visits for medication management, office-based substance use disorder treatment services and opioid treatment programs (OTPs) and Medicare.
Read this to learn more about behavioral health services Medicare pays for, and help improve the health of your patients!
