How To Use HCPCS Code G0446

HCPCS code G0446 describes an annual, face-to-face intensive behavioral therapy for cardiovascular disease, provided on an individual basis for a duration of 15 minutes. This code is used to identify and bill for the specific service of intensive behavioral therapy for patients with cardiovascular disease. In this article, we will explore the details of HCPCS code G0446, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0446?

HCPCS code G0446 is used to identify and bill for annual, face-to-face intensive behavioral therapy for cardiovascular disease. This therapy is provided on an individual basis and lasts for 15 minutes. It is an important service that aims to help patients with cardiovascular disease make positive lifestyle changes and improve their overall health outcomes.

2. Official Description

The official description of HCPCS code G0446 is “Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes.” The short description is “Intens behave ther cardio dx.”

3. Procedure

1. The provider initiates the annual, face-to-face intensive behavioral therapy session with the patient.
2. During the session, the provider assesses the patient’s cardiovascular disease and identifies areas for behavioral intervention.
3. The provider engages in a detailed discussion with the patient, focusing on lifestyle modifications, such as diet, exercise, and smoking cessation.
4. The provider educates the patient on the importance of adherence to prescribed medications and treatment plans.
5. The provider develops an individualized behavioral intervention plan tailored to the patient’s specific needs and goals.
6. The provider provides counseling and support to the patient, addressing any barriers or challenges they may face in implementing the recommended lifestyle changes.
7. The provider evaluates the patient’s progress and adjusts the behavioral intervention plan as necessary.
8. The provider documents the session and submits the appropriate billing using HCPCS code G0446.

4. When to use HCPCS code G0446

HCPCS code G0446 should be used when providing annual, face-to-face intensive behavioral therapy for cardiovascular disease on an individual basis. This therapy is specifically designed for patients with cardiovascular disease and aims to promote positive lifestyle changes to improve their overall health outcomes. It is important to ensure that the therapy session meets the criteria outlined in the official description of the code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0446, healthcare providers need to document the following:

• The date and duration of the therapy session
• A detailed description of the services provided during the session
• The patient’s cardiovascular disease diagnosis
• The individualized behavioral intervention plan developed for the patient
• The patient’s progress and any adjustments made to the intervention plan

Providers should ensure that the documentation supports the medical necessity of the therapy session and justifies the use of HCPCS code G0446. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0446 was added to the Healthcare Common Procedure Coding System on November 08, 2011. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use since its inception and continues to be an important tool for billing and reimbursement for annual, face-to-face intensive behavioral therapy for cardiovascular disease.

7. Medicare and Insurance Coverage

HCPCS code G0446 is covered by Medicare and other insurance providers. The pricing indicator code 13 indicates that the price for this service is established by carriers, based on carrier discretion. The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology. Providers should consult the specific guidelines and policies of Medicare and other insurance providers to ensure proper billing and reimbursement for this service.

8. Examples

Here are five examples of when HCPCS code G0446 should be billed:

1. A 55-year-old patient with a history of cardiovascular disease visits their primary care physician for an annual check-up. During the visit, the physician spends 15 minutes providing intensive behavioral therapy, discussing the importance of diet and exercise in managing their condition. HCPCS code G0446 should be billed for this service.
2. A cardiologist sees a 60-year-old patient who recently had a heart attack. The cardiologist spends 15 minutes providing intensive behavioral therapy, focusing on smoking cessation and stress management. HCPCS code G0446 should be billed for this service.
3. A nurse practitioner conducts a telehealth session with a 45-year-old patient who has been diagnosed with hypertension. The nurse practitioner spends 15 minutes providing intensive behavioral therapy, discussing the patient’s medication adherence and the importance of monitoring their blood pressure regularly. HCPCS code G0446 should be billed for this service.
4. A registered dietitian meets with a 50-year-old patient who has been diagnosed with obesity and cardiovascular disease. The dietitian spends 15 minutes providing intensive behavioral therapy, developing a personalized meal plan and discussing portion control. HCPCS code G0446 should be billed for this service.
5. A cardiac rehabilitation program offers group sessions for patients with cardiovascular disease. Each session lasts for 15 minutes, and the program follows the guidelines for annual, face-to-face intensive behavioral therapy. HCPCS code G0446 should be billed for each individual patient attending the group sessions.