SBIRT: Screening Tools, Brief Intervention & Billing Codes

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is a structured way to find risky alcohol and drug use early and respond in proportion to the risk. This guide covers the three SBIRT components, which SBIRT screening tools fit which population, how to deliver a brief intervention, when to refer, how to document it and the billing codes published by CMS and SAMHSA.

What Is SBIRT?

SBIRT is a comprehensive, integrated public health approach to delivering early intervention and treatment services for people with substance use disorders and people at risk of developing them (CMS, 2025). It grew out of decades of research on alcohol screening and brief intervention in primary care, emergency and trauma settings, later extended to illicit drugs, tobacco and prescription drugs (Babor et al., 2007).

SBIRT is delivered in primary care, emergency departments, specialty care and behavioural health settings. In a mental health practice it can sit inside the intake and periodic review: a substance use screen alongside the depression and anxiety scales, with a brief intervention or referral when the result calls for one.

The Three Components of SBIRT

1. Screening

A brief, validated questionnaire identifies risky use and estimates severity, which points to the appropriate level of response. CMS describes screening as the step that "quickly assesses a patient's substance use severity and identifies the appropriate treatment level" (CMS, 2025).

In the US, the Preventive Services Task Force recommends screening adults 18 and older in primary care for unhealthy alcohol use, with brief counselling for those who drink at risky levels, and screening adults by asking questions about unhealthy drug use when accurate diagnosis, treatment and care can be offered or referred (both grade B). For adolescents aged 12-17, it found the evidence insufficient to assess the balance of benefits and harms (I statements) (USPSTF, 2018; USPSTF, 2020). The American Academy of Pediatrics separately provides an adolescent SBIRT approach for pediatric settings (Levy et al., 2016).

2. Brief intervention

A short conversation (the Medicare codes run from 5 minutes to more than 30) that raises the client's awareness of risky use and builds motivation to change: feedback on the screen result, advice and a goal the client chooses (CMS, 2025). The brief intervention section below sets out a practical sequence.

3. Referral to treatment

When the screen or assessment shows a need for more than a brief intervention, the client is referred to specialty assessment and treatment. A referral is a warm handoff, not a phone number: the plan, the client's agreement and a follow-up check all belong in the note.

SBIRT Screening Tools: Which Fits Which Population

Choose the tool by age, by which substances you need to cover, and by how much detail you need from the first step. Each tool name links to its page in our assessment library, with scoring and cited cutoffs.

NIDA also lists S2BI, BSTAD and NIAAA's youth alcohol screen for adolescents (NIDA; NIAAA).

Quick picks

• Adults, several substances in one tool: TAPS or ASSIST.
• Adults, alcohol focus: AUDIT. Add the DAST-10 for drugs.
• Fast first pass in a busy intake: CAGE-AID, followed by a fuller tool when positive.
• Adolescents: CRAFFT.

Screening is not diagnosis. A positive screen calls for a clinical conversation and, where indicated, a full clinical evaluation.

How to Deliver a Brief Intervention

Brief interventions draw on motivational interviewing: a collaborative, non-confrontational conversation that strengthens the client's own reasons for change (Miller & Rollnick, 2013; see the motivational interviewing guide). Bien, Miller and Tonigan's review of brief alcohol interventions summarized their common elements as Feedback, Responsibility, Advice, Menu of options, Empathy and Self-efficacy (FRAMES) (Bien et al., 1993).

A practical sequence:

1. Ask permission to talk about the screen result.
2. Give feedback on the score and its risk band, in plain language.
3. Explore what the client sees as the pros and cons of their current use.
4. Assess readiness, for example on a 0-10 scale, and ask why they are not lower.
5. Advise and offer a menu of options, leaving the choice with the client.
6. Agree a goal and a follow-up, and write both in the note.

When to Refer to Treatment

Refer when the screen or the clinical picture suggests more than a brief intervention can address: high-risk scores, signs of a substance use disorder, withdrawal risk, co-occurring conditions that complicate management, or a client who wants specialty care. In the US, SAMHSA's FindTreatment.gov lists treatment programs. Document the referral, the client's response, and when you will follow up.

Documenting SBIRT

CMS expects the record to support the claim, including start and stop times or total face-to-face time for time-based codes, the assessment and clinical impression, and the plan of care (CMS, 2025). A short SBIRT entry, for example inside the Objective and Plan sections of a SOAP note:

Fictional example.

Screen: AUDIT = 12 (hazardous range). DAST-10 = 1.
Brief intervention (14:05-14:22, 17 min): feedback on AUDIT result;
client identified sleep and spending as reasons to cut down;
readiness 6/10. Goal chosen by client: no more than two drinking days
per week for the next month.
Referral: not indicated at this time.
Follow-up: re-administer AUDIT at the 4-week review.

SBIRT Billing Codes

Codes and descriptors below are summarized from the CMS Medicare Learning Network booklet MLN904084 (May 2025) and SAMHSA's SBIRT coding page. Payer rules, rates and eligible provider types change; confirm with the payer before billing.

Medicaid programs choose which codes to use for SBIRT, and the CMS booklet lists the G-codes above, the annual alcohol misuse screening and counselling codes G0442 and G0443, and H0049/H0050 as options (CMS, 2025; SAMHSA). The CMS booklet lists the provider types Medicare pays for SBIRT, which include clinical psychologists, clinical social workers, marriage and family therapists and mental health counsellors.

For the standardized mental health screens that often sit alongside SBIRT, such as the PHQ-9 and GAD-7, see CPT 96127. These are US codes; for Canadian billing see the Ontario, Alberta and Quebec guides.

SBIRT and Measurement-Based Care in HiBoop

A screen at intake is a snapshot. Repeating the same tool shows whether the brief intervention or treatment is working. HiBoop offers the TAPS, ASSIST and CRAFFT alongside the PHQ-9 and GAD-7, sends them on the schedule you set and scores them on submission, so substance use trends sit next to mood and anxiety in the same chart. The clinical response stays with you. See how to implement measurement-based care.