Alcohol Misuse Screening and Counseling - JE Part B

HCPCS/CPT Codes

• G0442 - Annual alcohol misuse screening, 15 minutes
• G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

Frequency

• G0442 - Annually
• G0443 - For those who screen positive, four times per year

Coverage

Screening:

All Medicare beneficiaries are eligible

Counseling:

Beneficiaries who screen positive are eligible if:

• They are competent and alert at the time counseling is provided; and
• Counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting

Counseling Requirements

Counseling is to be completed based on Five As Approach

1. Assess: Ask about or assess behavioral health risks and factors affecting choice of behavior change goals/methods.
2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0442 and G0443

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 180
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 210.8