Drug use screening and SBIRT for practices

Primary care, family medicine, internal medicine, OB-GYN and community health practices are asked to screen adults for unhealthy drug use and to offer a short conversation and a referral when the answers call for it. The clinical work is a few questions at a visit. The marketing around it is where practices get into trouble: a page that reads like a drug test, a reminder that tells a family member why the patient is coming in, an ad that promises recovery, or a page that quietly turns a primary care office into a federally regulated substance use program. This guide covers what the federal sources say about drug use screening, how SBIRT and its Medicare codes fit, where 42 CFR Part 2 enters, and how to word pages and messages so they stay accurate and private.

Related topics have their own guides and are not repeated here. Alcohol screening is covered in our guide to alcohol screening outreach, treatment programs in our guide to addiction treatment marketing, recovery housing in our guide to sober living marketing, ketamine clinics in our guide to ketamine clinic marketing, and behavioral health in primary care in our guide to behavioral health integration outreach.

This is general information, not legal, billing or medical advice. Sources cited were checked on October 30, 2026: the USPSTF recommendation Unhealthy Drug Use: Screening (final statement dated June 9, 2020) and the USPSTF list of recommendations in progress, the SAMHSA page SBIRT: Screening, Brief Intervention, and Referral to Treatment (last updated November 7, 2024), the CMS Medicare Learning Network booklet Screening, Brief Intervention and Referral to Treatment (SBIRT) Services (MLN904084, May 2025), 42 CFR 2.11 and 2.12, the final rule Confidentiality of Substance Use Disorder (SUD) Patient Records (89 FR 12472, February 16, 2024), 42 U.S.C. 300gg-13, 47 CFR 64.1200, 16 CFR 255.2 and 15 U.S.C. 45. Codes and payment rules change each year, Medicaid coverage is set by each state, and plan coverage differs by plan; check yours with your billing team and a health care attorney. If someone is in immediate danger, call 911.

What the USPSTF recommends

The U.S. Preventive Services Task Force final recommendation Unhealthy Drug Use: Screening is dated June 9, 2020. It recommends screening by asking questions about unhealthy drug use in adults age 18 years or older, a B grade, and adds that screening should be implemented when services for accurate diagnosis, effective treatment and appropriate care can be offered or referred. For adolescents, it concludes that the evidence is insufficient to assess the balance of benefits and harms, an I statement, and says clinicians should use their judgment about asking adolescents about drug use.

Three details in the statement shape the marketing. First, screening means asking questions, in person, on a form, a computer or a tablet. The Task Force says it does not refer to testing urine, saliva, blood or other specimens. Second, the recommendation does not apply to people who already have a diagnosed drug use disorder or who are in or have been referred to treatment. Third, its net benefit finding does not apply to settings where treatment cannot be provided or where the result of screening is punitive.

The Task Force defines unhealthy drug use as the use of substances, not counting alcohol or tobacco, that are illegally obtained, or the nonmedical use of prescription psychoactive medications, meaning use for reasons, for a duration, in amounts or at a frequency other than prescribed, or use by someone other than the person they were prescribed for. It found little evidence about the best age to start asking or the best interval for screening adults. It also says providers should be aware of state requirements and best practices on informed consent for screening, documenting results in the medical record and confidentiality protections.

Cite the June 9, 2020 date and the B grade for adults. On October 30, 2026, the topic was not on the Task Force list of recommendations in progress.
Describe screening as questions the care team asks, not a test. Never write “drug test” on a page about this recommendation.
Set up the referral path before you promote screening. The recommendation assumes diagnosis, treatment and care can be offered or referred.
Do not market drug use screening to teens or to parents as a way to check on a child. For adolescents the Task Force issued an I statement and left the question to clinician judgment.
Do not name a screening questionnaire in marketing. The clinician picks the tool.

What SBIRT means

SAMHSA describes Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a comprehensive, integrated, public health approach to early intervention and treatment services for people with substance use disorders and those at risk of developing them. Its three parts, in SAMHSA’s words: screening quickly assesses the severity of substance use and identifies the appropriate level of treatment; brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change; referral to treatment gives those identified as needing more extensive treatment access to specialty care.

That structure is useful for a practice page because it sets the limits of what primary care offers. A short conversation is not treatment, and a referral is not a promise of a bed or a program. The page should say what the practice does at the visit and that the clinician will talk through next steps, including a referral when one is needed.

Use: “Our clinicians ask adult patients a few questions about substance use and talk through the answers. If more care would help, we discuss options and referrals.”
Avoid: “Beat addiction in one visit,” “quick detox,” “we will get you clean.”
Do not describe brief intervention as therapy or as a treatment program unless the practice provides one and has decided, with counsel, how Part 2 applies (see below).

SBIRT billing codes as CMS lists them

The CMS Medicare Learning Network booklet on SBIRT services (MLN904084, May 2025) lists three HCPCS codes for alcohol and substance use (other than tobacco) misuse structured assessment and brief intervention:

G2011: structured assessment and brief intervention, 5 to 14 minutes.
G0396: structured assessment and brief intervention, 15 to 30 minutes.
G0397: structured assessment and intervention, greater than 30 minutes.

The booklet says Medicare covers reasonable and necessary SBIRT services provided to evaluate or treat patients with signs or symptoms of illness or injury, under section 1862(a)(1)(A) of the Social Security Act, and pays for them under the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System. It says the medical record must support the claim and must record start and stop times or total face-to-face time, since some of the codes are time-based. The physicians and nonphysician practitioners it lists as eligible to provide SBIRT services include physicians, physician assistants, nurse practitioners, clinical nurse specialists, clinical psychologists, clinical social workers, certified nurse-midwives, marriage and family therapists and mental health counselors.

For Medicaid, the same booklet says states may cover SBIRT under several benefit categories, that a state that covers it may choose which codes to bill, and that practices should check with their state Medicaid agency about which codes to use. It lists H0049 (alcohol and/or drug screening) and H0050 (alcohol and/or drug services, brief intervention, per 15 minutes) among the examples. Commercial plans use their own code sets; SAMHSA notes that reimbursement is available through commercial insurance CPT codes, Medicare G codes and Medicaid HCPCS codes.

Keep codes, payment amounts and copays off public pages. They change, and they mean little to patients.
Have the billing team confirm the current code set each January against the CMS booklet and the Physician Fee Schedule.
Do not tie the timing of a visit or a reminder to reaching a billable time threshold. The visit length follows the clinical need.

Coverage is not the same as the recommendation

Under 42 U.S.C. 300gg-13, group health plans and health insurers offering group or individual coverage must cover, with no cost sharing, items and services that have an A or B rating in current USPSTF recommendations. Drug use screening in adults has a B grade, so that rule reaches the service the Task Force describes: asking adults questions about drug use. It does not follow that treatment, a specimen test, a court or employer assessment, or adolescent screening is covered at no cost. Grandfathered plans are an exception, and coverage details differ by plan.

Medicare follows its own rules. The CMS booklet frames SBIRT as a reasonable and necessary service for patients with signs or symptoms, which is a different basis from a preventive screening benefit. Medicaid coverage depends on the state.

Use: “Ask your plan about coverage. Our team can check before your visit.” Avoid: “Free drug screening.”
Do not write “covered by Medicare” on a page about screening adults without symptoms unless your billing team has confirmed the basis in writing.

When a practice becomes a Part 2 program

Substance use disorder records can fall under a second federal privacy rule, 42 CFR Part 2, which has its own consent and disclosure requirements. Under 42 CFR 2.11, a Part 2 program is a person, other than a general medical facility, that holds itself out as providing, and provides, substance use disorder diagnosis, treatment or referral for treatment; an identified unit within a general medical facility that does so; or medical personnel or other staff in a general medical facility whose primary function is providing those services and who are identified as such providers. Under 42 CFR 2.12, the rules apply to federally assisted programs, and being a participating provider in the Medicare program is one of the listed forms of federal assistance. The same section lists private practitioners who hold themselves out as providing, and provide, those services among the programs covered.

The words “holds itself out” matter for marketing. A website, an ad or a directory listing that presents the practice, a unit or a named clinician as offering substance use disorder diagnosis, treatment or referral for treatment is part of how a practice holds itself out. A page about routine screening at a primary care visit reads differently from a page that advertises an addiction program. Whether a practice, a unit or a clinician is a Part 2 program is a question for a health care attorney, and the answer should be settled before the marketing goes live, not after.

HHS revised Part 2 in a final rule published February 16, 2024 (89 FR 12472), effective April 16, 2024. The rule states that persons subject to it must comply with its applicable requirements by February 16, 2026. Among other changes, it allows a patient to give a single consent for all future uses and disclosures for treatment, payment and health care operations, which the patient can revoke in writing.

Before a page says “addiction treatment,” “substance use disorder care” or “referral for treatment,” ask counsel whether that copy, together with your services, makes the practice, a unit or a clinician a Part 2 program.
If the practice is a Part 2 program, have counsel review consent forms, the notice, and any use of records in marketing or patient stories.
Keep provider bios accurate. Naming a clinician as the practice’s addiction specialist is a statement about their function.
Do not write how Part 2 applies to the practice on a public page unless counsel has confirmed it in writing.

Pages that inform without labeling the reader

A screening page is read by people who use drugs, by people who are worried about someone, and by people who just want to know what the visit includes. It should be calm, plain and short, and it should not ask the reader to admit anything on the page.

Explain that adult patients are asked a few questions about substance use, alcohol and tobacco as part of care, and that the answers go into the medical record like any other.
Say in plain words who sees the answers, what the practice must report under your state’s laws, and how a patient can ask questions about privacy. Ask counsel what applies before you publish it.
Link SAMHSA’s FindTreatment.gov as a resource for finding treatment.
Include: “If you are in immediate danger, call 911. If you are in crisis or having thoughts of suicide, call or text 988.”
Do not add a web form or chat prompt that asks the visitor about their drug use. Ask them to call or book a visit instead.
Do not run third party ad or analytics tags on screening or treatment pages, and do not build retargeting lists from them. Our guide to tracking pixels on practice websites covers the details.
Use no stock images of pills, needles or people in distress.

Claims and stories to leave out

Outreach for screening should invite a conversation, not sell a result. A practice cannot back up a promise of recovery from a few minutes at a visit, and the federal sources do not make one.

Avoid outcome promises: “quit for good,” “detox fast,” “recovery starts in one visit.”
Avoid fear headlines: “Is your patient hiding a drug problem?” or “Find out if you are an addict.”
Do not use a patient’s recovery story as an ad. Under 16 CFR 255.2(b), an ad that presents one consumer’s result is likely to be read as what others will generally achieve, unless that is substantiated or what people can generally expect is clearly disclosed, and claims must be truthful and substantiated under 15 U.S.C. 45.
Never publish a patient’s story, name or photo without a signed HIPAA authorization and counsel’s review of whether Part 2 also applies.
Do not frame screening as a giveaway, a contest or a discount.
Do not quote grant program statistics as if they were results the practice will achieve.

Reminders that keep the topic private

Screening is part of a visit, so the reminder is about the visit, not the topic. A text or voicemail can be seen by a family member, a partner or an employer who shares a device or a plan. These samples use placeholders; replace them with your own details.

Annual visit: “[Practice name]: It is time for your yearly visit. Call [phone] or book in the portal. Reply STOP to opt out.”
Follow-up: “[Practice name]: Please call [phone] to schedule a follow-up with [clinician name]. Reply STOP to opt out.”
Referral check-in, sent only if the patient agreed to this channel: “[Practice name]: [clinician name] asked us to check in. Call [phone] when it suits you. Reply STOP to opt out.”

Under 47 CFR 64.1200(a)(9)(iv), calls and texts to wireless numbers made by or on behalf of healthcare providers are exempt from prior express consent only when all of its conditions are met. They go only to the wireless number the patient provided, state the provider’s name and contact details, and are strictly limited to listed purposes, which include appointment and exam confirmations and reminders and wellness checkups. They contain no telemarketing, solicitation or advertising and no billing or other financial content, comply with HIPAA privacy rules, stay concise (generally 160 characters or fewer for a text), are limited to one message a day and three a week, and offer an easy opt out. Our guide to patient portal messages covers portal wording.

Keep the words drug, substance, addiction, screening result and referral out of texts, emails, voicemails, envelopes and lock screen previews.
Do not send a screening questionnaire by text or email. Ask the questions at the visit or in a private portal form the clinician has approved.
Honor a patient’s request to be contacted another way or at another address.

Illustration: two screening pages

This is an invented example to show the difference, not a real practice. Page A is titled “Drug testing and detox: get clean fast,” shows a photo of pills, runs an ad pixel, asks visitors to describe their drug use in a chat box, promises recovery and describes the practice as an addiction center without having asked counsel about Part 2. Page B is titled “Questions we ask at your yearly visit,” says the care team asks adults about alcohol, tobacco and drug use as the USPSTF recommends, explains that this is a conversation and not a lab test, says the clinician talks through options and referrals when they would help, explains privacy in plain words, links FindTreatment.gov, lists 911 and 988, and runs no ad tags. Page A overstates the service and may change the practice’s legal status. Page B matches the sources.

Checklist before drug use screening is promoted

USPSTF wording names the June 9, 2020 date, the B grade for adults 18 and older, and the I statement for adolescents.
Screening is described as questions, not a specimen test, and the referral path is set up before promotion.
SBIRT is described in SAMHSA’s terms, and brief intervention is not presented as treatment.
Codes are checked by the billing team against the current CMS booklet and fee schedule; no codes or prices on public pages.
Coverage wording separates the USPSTF grade, Medicare’s basis and Medicaid’s state choices.
Counsel has decided whether any page, service line or clinician bio makes the practice, a unit or a clinician a Part 2 program.
Pages carry 911 and 988, link FindTreatment.gov, have no ad tags and no form that asks about drug use.
Reminders never name the topic and meet the conditions in 47 CFR 64.1200(a)(9)(iv).
No outcome promises, no recovery stories in ads, no images of drugs or paraphernalia.
A clinician, the billing lead and a health care attorney approved the pages, the forms and the messages.

How we help

We build websites, local search, Google Ads, patient lead generation and AI front desk tools for independent practices and health businesses, including primary care and behavioral health practices. For drug use screening, that means a site that explains the visit in plain words, screening and resource pages with no ad tags, copy reviewed for Part 2 wording before it goes live, and reminders that never name the topic. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it.

Does the USPSTF recommend drug use screening?

Yes, for adults 18 and older, a B grade in the final statement dated June 9, 2020, when services for accurate diagnosis, effective treatment and appropriate care can be offered or referred. For adolescents it found the evidence insufficient, an I statement.

Does drug use screening mean a drug test?

No. The USPSTF defines screening as asking questions about drug use in person, on a form, a computer or a tablet. It says screening does not refer to testing urine, saliva, blood or other specimens.

What are the Medicare SBIRT billing codes?

The CMS booklet MLN904084 (May 2025) lists G2011 for 5 to 14 minutes, G0396 for 15 to 30 minutes and G0397 for more than 30 minutes of structured assessment and brief intervention. Medicaid code choices are set by each state.

Should we market drug use screening for teenagers?

No. The USPSTF found the evidence insufficient for adolescents and left the question to clinician judgment. Leave adolescent screening to the clinician and the practice’s own protocol, and do not market it to parents.

Does 42 CFR Part 2 apply to a primary care practice?

It can. Part 2 covers federally assisted programs that hold themselves out as providing, and provide, substance use disorder diagnosis, treatment or referral for treatment, and Medicare participation counts as federal assistance. How the practice describes its services is part of the question, so ask a health care attorney.

Can we text patients about drug use screening?

Send neutral visit reminders that do not name the topic, since someone else may see the phone. Healthcare texts without prior consent must meet all conditions in 47 CFR 64.1200(a)(9)(iv), and questionnaires belong at the visit.

Drug use screening outreach in primary care: USPSTF 2020, SBIRT, Medicare codes and 42 CFR Part 2