G0446, G0446 reimbursement, G0446 medicare guidelines

(2022) How To Bill G0446 – Description, Guidelines & Reimbursement

G0446 can be used for for face to face IBT for CVD and can be billed once a year. The description, medicare guidelines and reimbursement can be found below.

G0446 Description

G0446 can be billed for face to face IBT for CVD and is defined as: “Face to face IBT for CVD. Time units of 15 minutes. Individual. Annual.”

G0446 is included in the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE). Medicare contractors will apply their pricing to claims for G0446 when billed for IBT for CVD.

G0446 Medicare Guidelines

CMS covers G0446 one time as a 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.

Provider Specialty Codes

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

Provider Speciality Code 01: General Practice

Provider Speciality Code 08: Family Practice

Provider Speciality Code 11: Internal Medicine

Provider Speciality Code 16: Obstetrics/Gynecology

Provider Speciality Code 37: Pediatric Medicine

Provider Speciality Code 38: Geriatric Medicine

Provider Speciality Code 42: Certified Nurse Midwife

Provider Speciality Code 50: Nurse Practitioner

Provider Speciality Code 89: Certified Clinical Nurse Specialist

Provider Speciality Code 97: Physician Assistant

Place Of Service Codes

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

Place Of Service Code 11: Physician’s Office

Place Of Service Code 22: Outpatient Hospital;

Place Of Service Code 49: Independent Clinic ; or,

Place Of Service Code 71: State or local public health clinic.

G0446 Reimbursement

Medicare will allow payment for G0446 no more than once in a 12-month period. Any service extending the 12 month period won’t be reimbursed.

Medicare will not reimburse 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.

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

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