Starting in January 2007, the federal Medicaid program will pay for screening and brief intervention (SBI) programs for alcohol and other drug addiction.

The Centers for Medicare and Medicaid Services (CMS) recently added two new reimbursement codes for insurance claims: one for addiction screening, the other for brief-intervention services. The change was made to the HCSPCS Level II coding system.

"Fewer than 10 percent of adults with alcohol or drug disorders are identified and treated," said Eric Goplerud, director of the Ensuring Solutions to Alcohol Problems program at the George Washington University Medical Center, who worked with CMS on the SBI initiative. "The new codes will encourage doctors to address alcohol and drug problems, leading to a reduction in the tremendous social and medical costs associated with addiction. By adding these codes, CMS and the Office of National Drug Control Policy (ONDCP) are helping to make screening and brief intervention a routine part of primary and emergency medical care."

Goplerud told Join Together that the new codes would be "essential for expansion of SBI in public-sector programs," such as community health centers, Indian Health Service clinics, public hospitals, community mental-health centers, and migrant health centers. "It gives a financial base for the sustainability of these programs," he said, including those created under the Screening, Brief Intervention, Referral and Treatment (SBIRT) initiative by the federal Center for Substance Abuse Treatment.

The CMS codes won't have impact on SBI in private-sector facilities, but CSAT, Ensuring Solutions, ONDCP, and the group Physicians and Lawyers for National Drug Policy (PLNDP) have asked the American Medical Association (AMA) to add SBI to its Current Procedural Terminology (CPT) codes, which would clear the way for reimbursement for private insurance and Medicare.

A decision from the AMA on that request could come as soon as October, Goplerud said.

Meanwhile, Ensuring Solutions and groups like PLNDP, the American Society of Addiction Medicine, and Faces and Voices of Recovery continue to advocate for repeal of state Uniform Policy Provision Laws (UPPL), which allow insurers to deny payment for healthcare services if the victim of an accident is found to be under the influence of alcohol.

The UPPL laws have been cited as a major impediment to implementation of hospital-based SBI programs.

Ensuring Solutions has developed a guide to using the HCSPCS reimbursement codes; it is available online.