Check Claims History Before Billing G0443

Among the many new preventive services now covered under Medicare is screening and behavioral counseling interventions in primary care to reduce alcohol misuse. To be reimbursed for providing these services to Medicare beneficiaries, you’ll need to carefully follow the instructions.

For example, before you submit a claim for G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes check claims history for the patient to make sure a claim for G0442 Annual alcohol misuse screening, 15 minutes has been successfully submitted within a prior 12-month period.

The Centers for Medicare & Medicaid Services (CMS) instructs contractors in transmittal 2454 to deny claims that do not meet this criteria.

While you’re checking claims history, also make sure the patient hasn’t exceeded the maximum number of counseling services allowed. Medicare will only pay for up to four G0443 services within a 12-month period.

Source: MLN Matters article MM7791


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3 Responses to “Check Claims History Before Billing G0443”

  1. Dee Dee Pilette says:

    Is there any requirement for site? Would an out-patient educational facility quailify for this Gcode? Could this procedure be performed by a specialist not PCP?

  2. Angela T. says:

    According to MLN Matters Article #7633, the following practitioner types can use code G0442 and G0443: 01, 08, 11, 16, 37, 38, 42, 50, 89, and 97. The POS would be 11. I hope this helps.

  3. Angela T. says:

    Oops. I also forgot to include the other POS codes: 22, 49 and 71.

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