Medicare pays a primary care physician or other primary care practitioner in a primary care setting to annually provide one face-to-face behavioral counseling session for cardiovascular disease. Although CMS has developed a HCPCS code specifically for this service, many primary care clinicians perform this service as part of an E/M service or a wellness visit.
The code is defined as 15 minutes. In order to bill these, the record must show that the service took over half of the threshold time, or 7 ½ minutes. All Medicare patients are eligible for the service.
|National facility payment|
|G0446||Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes.||0.45||$26.71||$24.18|
The service has three components:
- The first is to encourage aspirin use for primary prevention a cardiovascular disease when the benefits outweigh the risks for men age 45-79 and women 55-79. (When the patient is in that age range.)
- The second is to screen for high blood pressure and all adults aged 18 and older.
- And the third is intensive behavioral counseling to promote a healthy diet for adults who already have hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular and diet related chronic diseases.
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