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 […]
Screening for Other Sexually Transmitted Illnesses (STI)
This article covers CPT® and diagnosis codes used for screening for other sexually transmitted illnesses. It includes descriptions and screening criteria. To tell whether or not you can collect a co-pay for the testing or not can be found on the U.S. Preventive Services Task Force (USPTF) website [1]. The Affordable Care Act mandated that […]
National Coverage Determination: PrEP for HIV Prevention | HCPCS Code G0011
Physicians and qualified health professionals (QHP) can gain reimbursement for up to eight counseling sessions per year for HIV risk assessment, risk reduction and medication adherence, according to a recently issued national coverage determination (NCD). Background On September 30, CMS issued a NCD 210.15, Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention, which shifts […]
Smoking Cessation, Substance Use Counseling, Screening, and Intervention Coding, 99406-99609
Although the use of tobacco products is on the decline in the United States, the consumption of alcohol and other addictive substances remains a common preventable problem. As a result, the American Medical Association’s (AMA’s) CPT Editorial Panel included a spotlight on reporting tobacco, alcohol, and substance use cessation, counseling, screening, and intervention codes in […]
HCPCS Code G0136 for Assessment Social Determinants of Health (SDoH)
HCPCS code G0136 for an assessment of patients a practitioner suspects may have difficulty with accessing treatment and following a treatment plan due to Social Determinants of Health (SDoH0 CMS established a standalone code G0136 (a HCPCS code) for the assessment of SDoH. They define SDoH into broad groups: “economic stability, education access and quality, […]
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
The US Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse and behavioral interventions for individuals whose screening results are positive. Medicare pays for an annual screening for alcohol misuse for all Medicare beneficiaries using HCPCS code G0442. For those who screen positive, Medicare also pays for a brief face-to-face behavioral counseling session, HCPCS […]
Coding and Reimbursement for Lactation Services
Questions about coverage and payment for breastfeeding and lactation counseling services come up regularly. And, payers change their policies. It is important to keep up-to-date with the commercial payers with which you have contracts. Is lactation counseling separately billable or considered part of the obstetrical package? What if the patient sees the physician and a […]
Screening Codes Guide – G0442, G0443, G0444, G0446, G0447
Medicare pays for some screening services for its beneficiaries, using HCPCS codes. These screening codes are time-based HCPCS codes with relatively low wRVU values and payment. This coding guide includes an explanation of the guidelines for each of these codes, and information about bundling, diagnosis coding, specialty and site of service restrictions, and much more.
Intensive Behavioral Counseling for Cardiovascular Disease, HCPCS Code G0446
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. […]
Screening for Depression | HCPCS Code G0444
G0444 Annual depression screening , 5—15 minutes According to Change Request 13710, beginning January 1, 2025, Medicare pays primary care practices to screen all Medicare patients annually for depression. The service must be provided in a primary care setting, in place of service office, outpatient hospital, independent clinic or in one of the following: 02 Telehealth […]
Behavioral Counseling for Obesity, HCPCS Code G0447
G0447 face-to-face behavioral counseling for obesity, 15 minutes G0473 Face-to-face behavioral counseling for obesity, group (2-10) 30 minutes Medicare pays for ongoing face-to-face behavioral counseling for patients with a body mass index (BMI) of ≥ 30, who are alert and able to participate in counseling. The service may be performed by a physician or non-physician […]