G0446 can be used for face-to-face IBT for CVD and can be billed once a year. The description, medicare guidelines, and reimbursement can be found below.
Description Of G0446
G0446 can be billed for face-to-face IBT for CVD and is defined as: “Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes”
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 once as a face-to-face CVD risk reduction visit annually for Medicare beneficiaries who are competent and alert when counseling is provided and furnished by a qualified primary care physician or another 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
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.
Medicare will allow payment for G0446 no more than once in 12 months. Any service extending the 12 months 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