How To Use HCPCS Code G0397

HCPCS code G0397 describes the structured assessment and intervention for alcohol and/or substance misuse, excluding tobacco, that lasts for more than 30 minutes. This code is used to identify and bill for services provided by healthcare providers to address alcohol and substance misuse issues in patients. In this article, we will explore the details of HCPCS code G0397, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0397?

HCPCS code G0397 is used to identify and bill for alcohol and/or substance misuse structured assessment and intervention services that last for more than 30 minutes. It is important to note that this code specifically excludes tobacco misuse. Healthcare providers use this code to document and report the time spent on assessing and intervening in cases of alcohol and substance misuse in patients.

2. Official Description

The official description of HCPCS code G0397 is “Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes.” The short description for this code is “Alcohol/subs interv >30 min.”

3. Procedure

1. The healthcare provider begins by conducting a structured assessment of the patient’s alcohol and/or substance misuse. This assessment may involve the use of tools such as the Alcohol Use Disorders Identification Test (AUDIT) or the Drug Abuse Screening Test (DAST).
2. Based on the assessment results, the provider develops an intervention plan tailored to the patient’s specific needs and goals.
3. The provider then spends more than 30 minutes delivering the intervention, which may include counseling, education, motivational interviewing, and referral to specialized treatment programs or support groups.
4. Throughout the intervention, the provider documents the time spent and the specific activities performed.

4. When to use HCPCS code G0397

HCPCS code G0397 should be used when healthcare providers perform a structured assessment and intervention for alcohol and/or substance misuse that lasts for more than 30 minutes. It is important to note that this code specifically excludes tobacco misuse. Providers should use this code when documenting and billing for services aimed at addressing alcohol and substance misuse issues in patients.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0397, healthcare providers need to ensure that they document the following:

• The time spent on the structured assessment and intervention, which should be more than 30 minutes.
• The specific activities performed during the intervention, such as counseling, education, motivational interviewing, and referrals.
• The results of the structured assessment, including any identified alcohol and/or substance misuse issues.
• The patient’s response to the intervention and any progress made towards addressing the alcohol and/or substance misuse issues.

Providers should also follow the billing guidelines set by Medicare or other insurance carriers to ensure accurate and timely reimbursement for the services provided.

6. Historical Information and Code Maintenance

HCPCS code G0397 was added to the Healthcare Common Procedure Coding System on January 01, 2008. As of October 01, 2020, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use for over a decade, providing healthcare providers with a specific identifier for billing structured assessments and interventions for alcohol and/or substance misuse.

7. Medicare and Insurance Coverage

HCPCS code G0397 is payable by Medicare and other insurance carriers. The pricing indicator code for this code is 11, which means that the price is established using national Relative Value Units (RVUs). The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. Healthcare providers should follow the reimbursement guidelines set by Medicare or other insurance carriers to ensure proper billing and reimbursement for the services provided using this code.

8. Examples

Here are five examples of scenarios where HCPCS code G0397 should be billed:

1. A primary care physician spends 45 minutes conducting a structured assessment and intervention for a patient with alcohol misuse issues, providing counseling and referral to a specialized treatment program.
2. A psychiatrist spends 60 minutes assessing and intervening in a patient’s substance misuse issues, utilizing motivational interviewing techniques and providing education on harm reduction strategies.
3. A licensed clinical social worker spends 40 minutes conducting a structured assessment and intervention for a patient with both alcohol and substance misuse issues, providing counseling and referrals to support groups.
4. A nurse practitioner spends 35 minutes delivering an intervention for a patient with alcohol misuse issues, utilizing cognitive-behavioral therapy techniques and providing education on the effects of alcohol on physical and mental health.
5. A certified addiction counselor spends 50 minutes conducting a structured assessment and intervention for a patient with substance misuse issues, utilizing the Drug Abuse Screening Test (DAST) and providing counseling on relapse prevention strategies.