Summary & Overview
HCPCS H0028: Alcohol/Drug Prevention Identification and Referral Service
HCPCS Level II code H0028 denotes alcohol and/or drug prevention problem identification and referral services, commonly used in student assistance and employee assistance program settings. The code is explicitly limited to identification and referral activities and does not include clinical assessment or treatment. Nationally, H0028 matters as part of broader public health and workplace wellness efforts to connect individuals at risk of substance misuse with appropriate resources before clinical intervention is required. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context and service settings for H0028, plus coverage and billing considerations relevant to major national payers. The publication summarizes typical use cases—school-based prevention, employer programs, and community outreach—highlights where H0028 fits in the continuum from prevention to assessment and treatment, and identifies gaps in available input data where specific coding linkages or payer-specific rules were not provided. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code H0028 describes an alcohol and/or drug prevention problem identification and referral service (for example, student assistance and employee assistance programs). The code covers services that identify substance use prevention needs and provide referral to appropriate resources; it explicitly does not include assessment services.
Service type: Prevention, screening, and referral for substance use
Typical site of service: School-based programs, workplace employee assistance programs, community prevention settings, and other non-clinical outreach environments
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A high school employee assistance counselor receives a referral from a school nurse about a 16-year-old student exhibiting signs of alcohol use and intermittent absenteeism. The counselor conducts a brief prevention problem identification and referral session focused on alcohol and/or drug concerns but does not perform a formal substance use assessment. The encounter includes history-taking about substance use patterns, screening with a brief validated tool or checklist, discussion of risks and school policy, provision of educational materials, and referral to specialized assessment or treatment resources (e.g., community substance use program, school-based clinician, or primary care provider). Documentation includes reason for contact, brief findings, educational interventions provided, referral disposition, and time/date. Typical sites of service include schools (student assistance programs), workplaces (employee assistance programs), community centers, and outpatient behavioral health clinics. The service is billed using H0028 for prevention problem identification and referral only, with no comprehensive assessment performed; follow-up occurs via referral tracking or brief check-in appointments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when documentation supports substantially greater effort or complexity for the referral visit (e.g., extensive coordination with multiple agencies). |