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New HCPCS code G0446 for Screening - Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)


A new HCPCS code, G0446, Annual, face-to-face IBT for CVD, individual, 15 minutes, will be included in the January 2012
updates of the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE), effective for services on or after November 8, 2011. For these services provided on or after November 8, 2011, through December 31, 2011, Medicare contractors will apply their pricing to claims for G0446 when billed for IBT for CVD.

Coverage and Limitation

CMS covers one face-to-face CVD risk reduction visit annually for Medicare beneficiaries who are competent and alert at the time that counseling is provided, and whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting.

Specialty Types

Only the following provider specialty types may submit claims for CVD risk reduction visits:

01-General Practice

08-Family Practice

11-Internal Medicine

16-Obstetrics/Gynecology

37-Pediatric Medicine

38-Geriatric Medicine

42-Certified Nurse Midwife

50-Nurse Practitioner

89-Certified Clinical Nurse Specialist

97-Physician Assistant

Place of Service

Medicare Contractors will pay claims for G0446 only when services are provided for the following Place of Service (POS):

11-Physician’s Office;

22-Outpatient Hospital;

49-Independent Clinic ; or,

71-State or local public health clinic.

For claims processed on or after April 2, 2012, Medicare will allow payment for G0446 no more than once in a 12-month period.

Medicare will not pay G0446 separately with another encounter/visit when billed on the same day. However, this does not apply to claims with the Initial Preventive Physical Examination (IPPE - HCPCS code G0402) containing modifier 59 or claims containing Diabetes Self-Management Training or Medical Nutrition Training services.

Deductible and Coinsurance

Medicare deductibles and coinsurance do not apply to claim lines containing HCPCS code G0446

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7636.pdf

Also see the complete list of Screening codes effective for the year 2012

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