G0396 HCPCS code: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
G0396 is the HCPCS Level II code for alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes. In 2024 Medicare paid an average of $24.59 per service for G0396 across 63,095 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume rose 14% from 2022 to 2024 (55,438 to 63,095 services). In 2024, about 1,346 clinicians billed Medicare for G0396 for 29,066 beneficiaries; Texas, California, Florida accounted for 50% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | M5D |
| Added | 2008-01-01 |
| Last action effective | 2020-10-01 |
Who bills G0396 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,346 |
| Medicare beneficiaries | 29,066 |
| States with claims | 36 |
| Share of services in top 3 states (Texas, California, Florida) | 50% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0396, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 55,438 | 26,793 | $33.63 | $24.81 |
| 2023 | 50,401 | 25,820 | $33.21 | $24.65 |
| 2024 | 63,095 | 29,066 | $32.76 | $24.59 |
States with the most G0396 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 14,114 | $25.52 |
| California | 9,532 | $25.20 |
| Florida | 7,989 | $26.27 |
| Tennessee | 6,024 | $20.76 |
| Maryland | 4,434 | $22.70 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for G0396
- 2008-01-01: G0396 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0396?
G0396 is the HCPCS Level II code for alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes. Short descriptor: "Alcohol/subs interv 15-30mn".
How much does Medicare pay for G0396?
In 2024, the average Medicare payment was $24.59 per service (average allowed $32.76).
Does Medicare cover G0396?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G0396 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G03 codes
- G0300 — Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
- G0302 — Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
- G0303 — Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
- G0304 — Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
- G0305 — Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
- G0306 — Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
- G0307 — Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
- G0308 — Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
- G0309 — Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
- G0310 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)
- G0311 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes)
- G0312 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)
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Next steps
- Run a reimbursement report for a device billed under G0396
- Watch G0396 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0396
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.