The Medicaid Helpline (518) 486-9057 phone number is currently being phased out.
Over the next several months, any calls to this number will receive a message directing the caller to (800) 541-2831. Medicaid Expands Coverage for Screening, Brief Intervention, and Referral to Treatment (SBIRT) Medicaid Coverage of Mental Health Counseling by LCSWs and LMSWs Billing Policy for Free-Standing Diagnostic and Treatment Centers (DTCs), including Renal Clinics and School Based Health Centers (SBHCs) Recipient Restriction Program Update Prenatal Care Providers Update Presumptive Eligibility Update Personal Care Benefit Update New York Health Options Enrollment Center Begins Processing Medicaid Renewals HIV Counseling and Testing Rate Codes to be Subsumed into APGs Free-Standing Rate Codes Subsumed by APGs to be Zeroed-Out Statutorily Required Breast Cancer Treatment Booklet Available Medicaid Obstetrical and Maternal Services (MOMS) Update Medicaid Provider Documentation Request EPIC Update New e PACES Training Schedule and Registration e Med NY Front-End (Pre-Adjudication) Edits Provider Enrollment and Screening Regulations Updated Medicaid Eligibility Verification System (MEVS) and Dispensing Validation System (DVS) Manual Now Available Point of Service Website Redesign & POS 5010 Software Upgrade e Med NY Provider Test Environment 5010/D.0 Testing Provider Directory Medicaid currently covers SBIRT services for all Medicaid beneficiaries who are 10 years of age and older in hospital outpatient and emergency departments and free-standing diagnostic and treatment centers (D&TCs), including School-Based Health Centers (SBHCs).
Table 1: Provider types eligible to bill for office-based SBIRT services 4 hours, unless certified by the American Society of Addiction Medicine (ASAM), the American Board of Ambulatory Medicine (ABAM), the American Academy of Addiction Psychiatry (AAAP)or the American Academy Osteopathic Association (AOA) DOCUMENTATION REQUIREMENTS Patient records must include information on the service provided, the score on the screening tool and a copy of the screening tool.
Providers are required to retain documentation that personnel performing SBIRT meet the OASAS required training, education and supervision requirements.
Unlicensed providers must be supervised by a licensed health care professional listed in Table 1 and must follow established written or electronic protocols for evidence-based practice during the delivery of screening and intervention services.
OASAS has a list of evidence-based screening tools available online at: Med/sbirt/
Upon prior approval from OASAS, providers may choose tools that are not included on the list as long as they meet specified criteria and the tool is simple enough to be administered by a wide range of health care professionals.
Reimbursement in other clinics, including those operated by or licensed by OMH and OASAS, will be available once Ambulatory Payment Groups (APGs) have been fully implemented in these settings.
SBIRT reimbursement is also authorized for services provided by federally qualified health centers that have opted in to the APG reimbursement methodology for their clinic services.
SCREENING: The screening tools identify substance use/abuse risk and the appropriate level of intervention for indicated individuals.
Providers must explain the screening results to the patient and, if the patient has screened positive, the provider must be prepared to deliver or obtain on-site brief intervention services for the patient within the same visit.
The following fee schedule will apply: Medicaid patients who are seen in hospital outpatient and emergency departments and free-standing clinics may receive SBIRT services from any of the providers listed in Table 1 or Table 2.
Payment in these settings is calculated as part of the established ambulatory payment group (APG) methodology.
Providers listed in Table 1 may bill for SBIRT directly.