Medicare Reimbursement for G0396 – Alcohol/Substance Abuse Intervention (15-30 Minutes)

HCPCS code G0396 describes a structured screening and brief intervention service for alcohol or substance misuse lasting 15 to 30 minutes. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is rendered, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ because the practice-expense RVU is higher in non-facility (e.g., office) settings, reflecting the overhead the billing provider incurs, versus lower facility-setting RVUs where the facility itself bears more overhead costs. This same formula is re-applied every year using updated RVUs, GPCIs, and conversion factor values.

RVUs — work 0.65, practice expense 0.4 (non-facility) / 0.16 (facility), malpractice 0.06 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

• This amount is an estimate only, not a guarantee of payment.
• Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
• Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
• Rates vary by locality due to GPCI differences; the national figure is not what every provider will receive.
• Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.