Preventive Services: Alcohol Misuse Screening and Counseling

September 1st, 2017 - Find-A-Code
Categories:   Medicare  
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The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Alcohol Misuse Screening and Counseling:

HCPCS/CPT Codes

G0442 - Annual alcohol misuse screening, 15 minutes
G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

ICD-10 Codes

See the CMS ICD-10 webpage for individual Change Requests (CRs) and coding translations for ICD-10, and contact your Medicare Administrative Contractor (MAC) for guidance.

Who Is Covered

All Medicare beneficiaries are eligible for alcohol screening.

Medicare beneficiaries who screen positive (those who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence) are eligible for counseling if:

  • They are competent and alert at the time counseling is provided and
  • Counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting

Frequency

  • Annually for G0442
  • For those who screen positive, 4 times per year for G0443

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived


Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.

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