CMS covers counseling to prevent STI in certain circumstances. The code is G0445.

G0445 – Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to- face, includes education skills training & guidance on how to change sexual behavior, performed semi-annually, 30 minutes.

The patient must be referred by a primary care provider to be eligible to receive this service, according to Medicare. Physicians, advanced practice nurses and physician assistants may provide the service.  The service must be performed in a Medicare-eligible primary care setting.

• • Use this code for individual face-to-face counseling, which includes education skills training and guidance on how to change sexual behavior.
  • The service can be provided to individuals with multiple sex partners, those who are using barrier protection inconsistently, those having sex under the influence of alcohol or drugs, those having sex in exchange for money or drugs, age (24 years or younger and sexually active for women with Chlamydia and gonorrhea) those who have had an STI within the past year, intravenous (IV) drug use (hepatitis B only) and for men having sex with men and engaging in high-risk sexual behavior.
  • The patient must be referred for this service by a primary care provider and the service must be provided by a Medicare-eligible primary care provider in a primary care setting. For the purpose of this service, Medicare defines a primary care physician as one of the following: general practitioner, family practitioner, general internist, obstetrician or gynecologist, geriatric medicine physician, pediatric medicine physician, clinical nurse specialist, nurse practitioner, or physician assistant.
  • A primary care setting is describe as one in which the provision of integrated accessible health care services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.[1]
  • This seems to require that the patient is referred by one of the above listed primary care specialty physicians. Or these services could be provided in a health department or infectious disease practice that provides the majority of the patient’s care.
  • These codes can be used for HIV negative or positive individuals.