G0442, G0443

(2022) HCPCS G0442 & G0443 – Descriptions, Reimbursement & Guidelines

G0442 and G0443 can be used to bill annual alcohol misuse. Both codes are billed in units of 15 minutes. CPT G0442 can be billed for alcohol misuse screening and G0443 can be used to report brief face to face counseling for alcohol misuse.

G0442

CPT G0442 can be billed for annual alcohol misuse screening of 15 minutes. It is defined as: “Annual alcohol misuse screening. Units of 15 minutes.”

G0443

CPT G0443 can be reported for a brief face to face counseling for alcohol misuse. This code is billed in units of 15 minutes and defined as: “Brief (face to face) behavioral counseling for alcohol misuse. Time unites of 15 minutes.”

Coding Guidelines For CPT G0442 & CPT G0443

CPT G0442 and CPT G0443 can be used for annual alcohol screening is covered for those that screen positive. A maximum of four, brief, face-to-face behavioral counseling interventions per year for Medicare beneficiaries.

G0442 and G0443 can be billed for pregnant women; who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance, withdrawal symptoms, impaired control, preoccupation with acquisition and/or use, persistent desire or unsuccessful efforts to quit, sustains social, occupational, or recreational disability, use continues despite adverse consequences).

G0442 and G0443 can be billed for pregnant women who are competent and alert at the time that counseling is provided.

G0442 and G0443 can be billed for pregnant women whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

Can We Bill Both G0442 And G0443 On The Same Day?

Medicare will allow payment for both G0442 and G0443 on the same date (except in RHCs and FQHCs), but will not pay for more than one G0443 service on the same date.

Coverage Limitations

Medicare will track payments for G0442 screening services and G0443 counseling services so as to not permit payment for G0442 more than once in a 12-month period, and for G0443 no more than 4 times in a 12-month period, beginning with the date of the G0442 service.

Claim lines exceeding these limits will be denied using:

CARC 119: Benefit maximum for this time period or occurrence has been reached.

RARC N362: The number of days or units exceeds our acceptable maximum.

Deductible And Coinsurance

Deductible and coinsurance do not apply for both G0442 and G0443

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