Intensive Behavioral Therapy (IBT) for Cardiovascular Disease - JE Part B

HCPCS/CPT Codes

G0446 - Annual, face-to-face intensive behavioral therapy for cardiovascular disease

Frequency

Annually

Coverage

• Beneficiaries competent at time of counseling; and
• Furnished by qualified primary care physician or other primary care practitioner and in primary care setting

Therapy Components

• Encouraging aspirin use for men ages 45-79 and women ages 55-79
• High blood pressure screening for adults ages 18 and older; and
• Intensive behavioral counseling to promote a healthy diet for adults with hypertension, advancing age, and other known risk factors for cardiovascular- and diet-related chronic disease

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 patient's interest in and willingness to change behavior
4. Assist: Using behavior change techniques (self-help and/or counseling), aid 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 treatment plan as needed, including referral to more intensive or specialized treatment

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0446

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 160
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 210.11