HCPCS G0397: Substance interventionMedicare rate & RVUs in Delaware
Structured alcohol or non-tobacco substance-use assessment and intervention lasting more than 30 minutes, with feedback, motivational counseling, and referral planning when indicated.
Medicare pays $67.19 for G0397 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What G0397 covers
G0397 describes a structured assessment and intervention for alcohol or other substance use, excluding tobacco. The encounter may include reviewing a screening result, discussing health and safety risks, providing motivational feedback and advice about reducing or stopping use, and planning a treatment referral when indicated. It is used for focused clinician-patient encounters in settings such as primary care and outpatient care.
Choose G0397 when the documented time for the structured assessment and intervention exceeds 30 minutes; 15 through 30 minutes is reported with G0396. Document the assessment findings, intervention provided, time spent on this service, the patient’s response, and any referral or follow-up plan. The time should reflect the assessment and intervention rather than unrelated evaluation or routine counseling.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
G0397 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $67.19 | $54.98 |
How the G0397 rate is calculated
Each of G0397’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0397
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.30Practice expense 0.65Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0397
G0397 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G0397
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$67.47
The facility rate would be $55.11 (+$12.36). In a facility, the facility bills its own costs separately.
G0397 compared with similar codes
Compare codes
G0397 vs G0396 vs G0442 vs G0443 vs 99409: national Medicare rates
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How to choose
- G0396Brief intervention
- Both describe structured alcohol or non-tobacco substance-use assessment and intervention. Use G0397 for more than 30 minutes and G0396 for 15 through 30 minutes.
- G0442Alcohol screening
- G0442 is an alcohol misuse screening service. G0397 describes a longer assessment and intervention, not screening alone.
- G0443Alcohol counseling
- G0443 is brief counseling focused on alcohol misuse. G0397 covers a longer structured intervention and can address other substances besides tobacco.
- 99409Audit/dast over 30 min
- 99409 is a related code for screening and brief intervention lasting more than 30 minutes. G0397 is the HCPCS code used for this service in Medicare reporting.
G0397 billing questions
How does G0397 differ from G0396?
G0397 is for a structured alcohol or non-tobacco substance-use assessment and intervention lasting more than 30 minutes. G0396 is used when the service lasts 15 through 30 minutes.
Does G0397 include tobacco counseling?
No. G0397 covers alcohol or other substance use, excluding tobacco.
Can a screening alone support G0397?
A screening alone does not describe the structured assessment and intervention represented by G0397. Documentation should show the intervention delivered and the time spent on the service.
What time should the record support?
Document the time spent on the structured assessment and intervention, and show that it exceeds 30 minutes. Do not include unrelated evaluation or routine counseling time in that total.
How does G0397 differ from G0443?
G0443 describes brief counseling for alcohol misuse. G0397 represents a longer structured assessment and intervention and can address substances other than alcohol, excluding tobacco.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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