• Screen before you counsel for alcohol misuse

    The Centers for Medicare & Medicaid Services recently issued further instructions for contractors processing claims for the preventive medicine benefit for alcohol misuse counseling, which was added last fall. If a claim is submitted for code G0443 (brief face-to-face behavioral counseling for alcohol misuse, 15 minutes) when there are no claims for code G0442 (annual alcohol misuse screening, 15 minutes) in the prior 12 months, the contractor will deny the claim for G0443. The article also reminds contractors and physicians that Medicare will only pay for up to four G0443 services within a 12-month period. Claims for G0443 that exceed that four session limit in a 12-month period will be rejected.

    Some other reminders about these services:

    • Medicare will allow payment for both G0442 and G0443 on the same date (except in rural health clinics and federally qualified health clinics), but will not pay for more than one G0443 service on the same date.
    •  Code G0442 is an annual benefit so at least 11 months must pass between services.
    • Both the screening and counseling services have time elements of 15 minutes, so time should be documented in addition to screening or counseling notes.
    • Counseling for alcohol misuse must be based on the Five As (Assess, Advise, Agree, Assist, and Arrange), so be sure your documentation reflects this.
    • The alcohol screening and counseling services are payable with another visit on the same day (e.g., office visit for other problems), except for the Initial Preventive Physical Exam ("Welcome to Medicare" physical).
    • These services are not subject to deductible or co-insurance.
    • National average fee schedule amounts for these services are $17.36 for G0442 and $25.19 for G0443.

    You can find further details on this and other preventive medicine benefits covered by Medicare Part B in Chapter 18 of the Medicare Claims Processing Manual.

    Posted on May 21, 2012 by Cindy Hughes

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.