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 provide (get paid for) up to eight counseling sessions per year for HIV risk assessment, risk reduction and medication adherence, according to a national coverage determination (NCD) issued in 2024. Background On September 30, 2024 CMS issued a NCD 210.15, Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) […]
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 Update
CMS is changing the definition of HCPCS code G0136. They are keeping the code, and the valuation of the code. The code is staying on the telehealth list. But there is a completely new definition. Between now and 12/31/2025, G0136 is for an assessment of a patient in the areas of social determinants of health […]
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
Information about these services, and other screening/preventive care is found on the CMS website CMS MLN Medicare Preventive Services Educational Tool. The reference is now MLN006559. The page was updated in 2025 to include: Added crisis support contact information Added information for safety planning for patients at risk for suicide Added information for follow-up contacts […]
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, using one of the following place of service codes: 02 Telehealth provided other than in patient’s […]
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 […]