Screening and Behavioral Counseling to Reduce Alcohol Misuse
Effective with dates of service on and after Oct. 14, 2011, CMS covers annual alcohol screening, and for those that screen positive, up to four, brief, face-to-face behavioral counseling and interventions per year for Medicare beneficiaries, including pregnant women:
- Who use alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence; and,
- Who are competent and alert at the time that counseling is provided, and;
- Whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.
Services may be provided by the following specialty types:
01 - General Practice
08 - Family Practice
11 - Internal Medicine
16 - Obstetrics/Gynecology
37 - Pediatric Medicine
38 - Geriatric Medicine
42 - Certified Nurse Midwife
50 - Nurse Practitioner
89 - Certified Clinical Nurse Specialist
97 - Physician Assistant
These services may be provided in the following places of service:
11 - Physician Office
22 - Outpatient Hospital
49 - Independent Clinic
50 - Federally Qualified Center
71 - State or local public health clinic
72 - Rural Health Clinic
Two new G codes have been established:
G0442 - Annual alcohol misuse screening, 15 minutes
G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
These codes will appear on the January 2012 Medicare Physician Fee Schedule update and the Integrated Outpatient Code Editor.
Rural Health Clinics (type of bill 71X) and Federally Qualified Health Centers (type of bill 77X) are allowed to submit additional revenue lines with the G0442 and G0443. Payment will be made on the all-inclusive payment rate.
In a PPS hospital outpatient department (TOB 13x), payment will be made under the OPPS payment methodology. In a Critical Access Hospital (type of bill 85X), payment will be based on reasonable cost. As a Critical Access Hospital if these services are billed under Method II with revenue codes 96X, 97X or 98X, payment will be based on 115% of the lesser of the actual charge or the Medicare Physician Fee Schedule. Deductible and coinsurance do not apply.
Intensive Behavioral Therapy for Cardiovascular Disease
Effective for claims with dates of service on and after Nov. 8, 2011, CMS covers intensive behavioral therapy for cardiovascular disease (CVD), inclusive of one face-to-face risk reduction visit annually. Coverage consists of the following three components:
- Encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risk for men age 45-79 years and women 55-79 years;
- Screening for high blood pressure in adults age 18 years and older; and,
- Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular and diet-related chronic disease.
Services may be provided by the following specialty types:
01 - General Practice
08 - Family Practice
11 - Internal Medicine
16 - Obstetrics/Gynecology
37 - Pediatric Medicine
38 - Geriatric Medicine
42 - Certified Nurse Midwife
50 - Nurse Practitioner
89 - Certified Clinical Nurse Specialist
97 - Physician Assistant
These services may be provided in the following places of service:
11 - Physician Office
22 - Outpatient Hospital
49 - Independent Clinic
50 - Federally Qualified Health Center
72 - Rural Health Clinic
A new HCPCS code G0446 has been established for annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes.
This code will appear on the January 2012 Medicare Physician Fee Schedule update and the Integrated Outpatient Code Editor.
Rural Health Clinics (type of bill 71X) and Federally Qualified Health Centers (type of bill 77X) are allowed to submit additional revenue lines with the G0446. Payment will be made on the all-inclusive payment rate.
In a PPS hospital outpatient department (TOB 13x) payment will be made under the OPPS payment methodology. In a Critical Access Hospital (type of bill 85X), payment will be based on reasonable cost. As a Critical Access Hospital if these services are billed under Method II with revenue codes 96X, 97X or 98X, payment will be based on 115% of the lesser of the actual charge or the Medicare Physician Fee Schedule. Deductible and coinsurance do not apply.
Screening for Depression in Adults
Effective for claims with dates of service on and after Oct. 14, 2011, Medicare covers annual depression screening for adults in the primary care setting. These services are covered in a primary care setting that has "staff-assisted depression care supports" in place to assure accurate diagnosis, effective treatment and follow-up.
At a minimum level, "staff assisted depression care supports" consist of clinical staff (i.e. nurse, Physician Assistant) in a primary care office who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. More "comprehensive care supports" include a case manager working with the primary care physician; planned collaborative care between the primary care provider and mental health clinicians, patient education and support for patient self-management; plus attention to patient preferences regarding counseling, medications, and referral to mental health professionals with or without continuing involvement by the patient's primary care physician.
Coverage is limited to screening services and does not include treatment options for depression or any disease, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications), or other interventions for depression. Self-help materials, telephone calls and web-based counseling are not separately reimbursable by Medicare.
These services may be provided in the following places of service:
11 - Physician Office
22 - Outpatient Hospital
49 - Independent Clinic
50 - Federally Qualified Health Centers
71 - State or local public health clinic
72 - Rural Health Clinic
A new HCPCS code has been established of G0444 for annual depression screening, 15 minutes.
This code will appear on the January 2012 Medicare Physician Fee Schedule update and the Integrated Outpatient Code Editor.
Rural Health Clinics (type of bill 71X) and Federally Qualified Health Centers (type of bill 77X) are allowed to submit additional revenue lines with the G0444. Payment will be made on the all-inclusive payment rate.
In a PPS hospital outpatient department (TOB 13x), payment will be made under the OPPS payment methodology. In a Critical Access Hospital (type of bill 85X), payment will be based on reasonable cost. As a Critical Access Hospital if these services are billed under Method II with revenue codes 96X, 97X or 98X, payment will be based on 115% of the lesser of the actual charge or the Medicare Physician Fee Schedule. Deductible and co-insurance do not apply.
Please contact JoNell Moore at jmoore@eidebailly.com with any additional questions.
