HCPCS G0442 & HCPCS G0443 | Descriptions, Procedures & Guidelines
HCPCS code G0442 can be billed for the screening of alcohol misuse, and HCPCS code G0443 can be reported for behavioral counseling for alcohol misuse.
1. What Is HCPCS Code G0442?
Report the HCPCS G0442 when the provider screens a patient for the presence of alcohol abuse.
The provider performs this screening examination on an annual basis, and the duration of the service lasts for 15 minutes.
1.1 Description
G0442 is officially described by HCPCS as follows: “Annual alcohol misuse screening, 15 minutes.”
1.2 Procedure
The HCPCS code G0442 procedure covers a patient screening for alcohol abuse. They provide this service to patients who experience psychological, social and/or physical harm from the use of alcohol. The individual is not dependent on alcohol.
A primary care clinician usually performs this service in a primary care setting.
This service can be provided in the following places;
- an independent clinic;
- outpatient hospital; or
- the provider’s office.
This procedure takes 15 minutes and is time-based.
1.3 Billing Guidelines
Medicare covers only one screening session of HCPCS G0442 per 12 months if submitted by a psychiatrist.
CMS may allow coverage for G0442 if the service was provided by a;
- Physician Assistant;
- Certified Clinical Nurse Specialist;
- Nurse Practitioner;
- Certified Nurse Midwife;
- Geriatric Medicine;
- Pediatric Medicine;
- Obstetrics and Gynecology;
- Internal Medicine;
- Family Practice; and
- General Practice.
The patient must sign an ABN (Advance Beneficiary Notice) if you want to collect the Medicare beneficiary for G0442. Make sure to add Modifier GA to the claim.
2. What Is HCPCS Code G0443?
Report the HCPCS G0443 code when the provider offers behavioral counseling for alcohol misuse to a patient in person. The duration of counseling lasts 15 minutes.
2.1 Description
HCPCS code G0443 is officially described as follows: “Annual alcohol misuse screening, 15 minutes.”
2.2 Procedure
The G0443 procedure covers a provider screening a patient for alcohol misuse. He provides this service to an individual currently experiencing physical, social, and psychological harm from alcohol use but may not have a dependence problem.
The provider offering the service is typically a primary care clinician in a primary care setting. The patient receives the service in the provider’s office, outpatient hospital, or independent clinic.
G0443 is time-based, and the provider will take 15 minutes the interaction with the patient.
2.3 Billing Guidelines
Medicare covers HCPCS G0443 up to four times a year. The year starts on the date of service of G0442 for screening for alcohol misuse.
You can not bill G0443 before the G0442 service is performed. However, performing G0442 and G0443 on the same date (RHCs and FQHCs are excepted) is possible.
Make sure that an Advance Beneficiary Notice is signed by the patient and submitted with the claim in conjunction with the GA modifier.
3. Resources
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r2358cp.pdf
