Alcohol Misuse Screening and Counseling

The American Academy of Pediatrics (AAP) Bright Futures initiative recommends tobacco, alcohol, and drug use screening and assessment with appropriate follow-up action as necessary, beginning at age 11. Additionally, the United States Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in primary care settings in adults 18 years of age and older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.

The Department of Health Care Services (DHCS) released All Plan Letter (APL) 21-014 on October 11, 2021, which outlines the requirement for SABIRT services. APL 21-014 supersedes APL 18-014, which noted required services for Alcohol Misuse Screening and Counseling (AMSC).

Blue Shield Promise will process your claim through its normal channels for claim reimbursement. The following HCPCS codes may be used to bill for SABIRT services as outpatient services only:

Please note that HCPCS codes H0049 and H0050 are reimbursable “by report.” An attachment documenting the services delivered must be submitted with claims for H0049 and H0050. For more information, visit the Evaluation & Management (E&M) section of the Medi-Cal Provider Manual.

Blue Shield Promise Medi-Cal members who are ages 11 and older, including pregnant women.

Blue Shield Promise members 11 years of age and older must be screened for alcohol and drug misuse once annually in primary care settings. Providers must document in the member’s medical chart that SABIRT was administered.

Screening

Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:

• Cut Down, Annoyed, Guilty, Eye-Opener Adapted to Include Drugs (CAGE-AID)
• Tobacco, Alcohol, Prescription medication, and other Substances (TAPS)
• National Institute on Drug Abuse (NIDA) Quick Screen for adults
• The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening.
• Drug Abuse Screening Test (DAST-10)
• Alcohol Use Disorders Identification Test (AUDIT-C)
• Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
• Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
• Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population

Brief Assessment

When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or substance use disorder (AUD or SUD) is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools.

Validated assessment tools include, but are not limited to:

• NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
• Drug Abuse Screening Test (DAST-20)
• Alcohol Use Disorders Identification Test (AUDIT)

Brief Interventions and Referral to Treatment

For members with brief assessments that reveal unhealthy alcohol use, brief misuse counseling should be offered. Appropriate referral for additional evaluation and treatment, including medications for addiction treatment, must be offered to recipients whose brief assessment demonstrates probable AUD or SUD.

Alcohol and/or drug brief interventions include alcohol misuse counseling and counseling a member regarding additional treatment options, referrals, or services. Brief interventions must include:

• Providing feedback to the patient regarding screening and assessment results
• Discussing negative consequences that have occurred and the overall severity of the problem
• Supporting the member in making behavioral changes
• Discussing and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated

Documentation Requirements

Member medical records must include:

• The service provided (e.g., screen and brief intervention)
• The name of the screening tool and the score (unless the screening tool is embedded in the electronic health record)
• The name of the assessment instrument (when indicated) and the score on the assessment (unless the screening tool is embedded in the electronic health record)
• If and where a referral to an AUD or SUD program was made

Consistent with AAP and USPSTF recommendations, providers must annually screen adult and child members 11 years of age and older for alcohol and drug misuse. Although Blue Shield Promise will reimburse providers only for once-annual alcohol and drug misuse screenings, additional screenings must be provided when medically necessary. Medical necessity must be documented by the member’s PCP or primary care team.

Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:

• Cut Down, Annoyed, Guilty, Eye-Opener Adapted to Include Drugs (CAGE-AID)
• Tobacco, Alcohol, Prescription medication, and other Substances (TAPS)
• National Institute on Drug Abuse (NIDA) Quick Screen for adults
• The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening
• Drug Abuse Screening Test (DAST-10)
• Alcohol Use Disorders Identification Test (AUDIT-C)
• Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
• Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
• Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population

When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or SUD is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools. Validated assessment tools include, but are not limited to:

• NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
• Drug Abuse Screening Test (DAST-20)
• Alcohol Use Disorders Identification Test (AUDIT)

See links to alcohol and drug screening tools (PDF, 232 KB)

As needed, providers with appropriate license and certification may provide Medications for Addiction Treatment (also known as Medication-Assisted Treatment) provided in primary care, inpatient hospital, emergency departments, and other contracted medical settings.

Providers can and should also refer members to substance use disorder (SUD) treatment services in the county where the member lives. To make referrals, explore directories of SUD services in your area, or contact the SUD Resource Center at (800) 879-2772.

If you have questions, contact Blue Shield Promise’s Behavioral Health Department: PromiseBehavioralHealth@blueshieldca.com

Reference materials

• APL 21-014
• Links to alcohol and drug screening tools (PDF, 232 KB)
• SABIRT flyer with screening codes (PDF, 259 KB)

Resources

Provider resources for brief interventions include:

• Brief Negotiated Interview (BNI)
• The Substance Abuse and Mental Health Services Administration (SAMHSA) website

Referrals

• SUD Directories
• Members requiring treatment for SUD will receive services through their county of residence (Los Angeles or San Diego). For further assistance with SUD referrals, you may contact:
  • San Diego Access & Crisis Line: (888) 724-7240
  • Los Angeles County Substance Abuse Service Helpline (SASH): (844) 804-7500