HCPCS codes G0442 and G0443 (2021)

ffective for claims with dates of service October 14, 2011, and later, CMS would cover annual alcohol screening, and for those that screen positive, up to four, brief, face-to-face behavioral counseling interventions per year for Medicare beneficiaries, including 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); and,

• who are competent and alert at the time that counseling is provided; and,

• whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

HCPCS codes and effective date

Two new G codes, G0442 (Annual Alcohol Misuse Screening, 15 minutes), and G0443 (Brief face-to-face behavioral counseling for Alcohol Misuse, 15 minutes), are effective October 14, 2011, and will appear in the January quarterly update of the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE). For claims with Dates of Service on or after October 14, 2011, through December 31, 2011, Medicare contractors will use their pricing to pay for G0442 and/or G0443.

Specialty Types

Effective for claims with dates of service on and after October 14, 2011, contractors shall accept and pay claims for G0442 and G0443 only when services are submitted by the following provider specialty types found on the provider’s enrollment record:

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

For purposes of this covered service, the following place of service (POS) codes are applicable:

11-Physician’s Office

22-Outpatient Hospital

49-Independent Clinic

71-State or local public health clinic

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

Reference: http://www.cms.gov/transmittals/downloads/R2358CP.pdf

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

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