Medicare Coverage of Alcohol Screenings & Behavioral Interventions: A Guideline for Providers

Date: 

12/24/2013

The Medicare Learning Network within the Centers for Medicare & Medicaid Services has published a guide for providers on changes in health laws that enhance a physician’s ability to address alcohol and substance use issues with their patients. Included in this guide is Medicare coverage information, behavioral counseling and intervention resources, and billing services guidelines.

Medicare insurance now covers annual alcohol misuse screenings and four in-person counseling sessions per year in primary care settings such as clinics, outpatient hospitals, and physician offices offering integrated care for the health needs of families and communities. Telehealth services are also expanded to include Medicare-covered screenings and counseling aimed at reducing alcohol misuse.

Although screening and counseling tools are not specifically outlined in the guide, the US Preventive Services Task Force (USPTSF) has issued an approach to behavioral counseling sessions that incorporate use of the 5As:  assess, advise, agree, assist, and arrange. Physicians should conduct behavioral interventions consistent with the 5As’ approach. The USPTSF also has a fact sheet with a range of recommendations for behavioral health services that should be offered to patients depending on their age and gender. The topics are categorized by priority and Medicare covers all A- and B-level screenings, some of which include HIV screening, tobacco use and tobacco-caused disease counseling, and obesity screening and counseling.

Billing for these interventions and behavioral services under Medicaid is becoming more streamlined through the increased use of electronic formats. Behavioral health screening and intervention claims can be submitted, billed for, and reviewed online. More detailed information on specific coding and payment options are covered in this guide, as well as resources for providers and beneficiaries on screening and counseling interventions in primary care to reduce alcohol misuse. The decision memo can be found at http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=249.

The evidence base for this recommendation can be found in the AHRQ Report - Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse. The USPSTF consumer fact sheet of approved services can be found here: USPSTF Preventive Services Recommendations for Behavioral Health. A summary of the clinical guideline may be found at http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisusefinalrs.pdf.