Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
Members 11 years and older who are screened for unhealthy alcohol use in primary care settings and providing persons 18 years and older engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use in the measurement year.
Incentives will be paid on an annual basis, following the end of quarter 4. For additional information refer to the 2021 CBI Technical Specifications.
Note: Alcohol screening and treatment services are reimbursed outside of regular capitated rates. For both capitated and non-capitated Alliance providers, the Alliance will reimburse 150% of Medi-Cal rates to our contracted providers.
FQHCs may want to review how these payments effect State reconciliation cost reporting. FQHC / Rural Health Center tip: Do not bill the Alliance for more than what Medi-Cal allows to avoid repayment.
The Alliance will reimburse providers who provide services for unhealthy alcohol use. These services are not reimbursable for drug-related services. Unhealthy alcohol use screening and behavioral counseling services may be provided on the same day as other Evaluation and Management (E&M) services.
- G0442: Annual alcohol misuse screening, 15 minutes (11 years and older)
- G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (18 years and older)
For LOINC Coding submissions in the Data Submission Tool:
- Single use questionnaires (Ex. Staying Healthy Assessments):
- 88037-7 (Men 18 years and older): How often have you had five or more drinks in one day during the past year
- 75889-6 (Women 18 years and older & Older Adults): How often have you had four or more drinks in one day during the past year
- AUDIT screening tools
- 75624-7: AUDIT
- 75626-2: AUDIT-C
Primary care providers and integrated practice models with Behavioral Health therapists may offer alcohol misuse screenings. Alcohol misuse screening services performed by Behavioral Health therapists under the same clinic NPI are eligible for CBI payment. Claims submitted to Beacon will not qualify for CBI payment. Beacon may not reimburse for these services since they are intended to be a primary care service.
Data for this measure will be collected using provider data submissions via the Data Submission Tool on the Provider Portal, and claims.
- Run a report from your EHR system
- Manually compile patient data (Example: Download monthly breast cancer screening quality report on the Provider Portal and compare to EHR)
This measure allows providers to submit alcohol screenings from the clinic EMR/EHR system or paper records to the Alliance at the end of the measurement year by uploading data files to the Data Submission Tool on the Provider Portal. The files are required to be submitted as a CSV file to be accepted. A Data Submission Tool Guide is available on the Provider Portal to provide you with step-by-step instructions.
For adults and adolescents, providers are required to use a Medi-Cal approved screening instrument (AUDIT/AUDIT-C) for the initial full screening (G0442); a pre-screen or brief screen is not reimbursable. Example questions and scoring for the Audit and Audit-C can be found here: https://sbirt.webs.com/AUDIT-C%20and%20AUDIT%20Adolescents.pdf
The brief intervention (G0443) may include an initial intervention, a follow-up intervention and/or a referral; and can take place on the same date of service as the initial screening (G0442) or on subsequent days. Brief interventions may be offered in-person, by telephone, or by telehealth modalities.
AAP’s Bright Futures recommends:
- Youth aged 11 years and older should be screened for alcohol and other drugs (AOD) use at each annual preventive health
- Providers begin with open ended questions about substance use at home, school, and by peers before progressing to open-ended questions about personal use. See the Alcohol Screening and Brief Intervention for Youth A Practitioners Guide for more details.
- Reviewing the adolescent’s environment for risk and protective factors for the development of alcohol or drug use and abuse
- Creating opportunities for confidential discussion between the adolescent and provider1
- CRAFT (Car, Relax, Alone, Friends, Forget, Trouble) is a well-validated substance use screening tool for adolescents that can be self-administered or be completed by a patient and as an interview tool administered by a provider. Information is available at http://crafft.org/
- CAGE (Cut-Annoyed-Guilty-Eye) The CAGE is a simple screening questionnaire to identify people with potential problems with alcohol. Two “yes” responses are considered positive for males; one “yes” is considered positive for females.
© 2021 Central California Alliance for Health