Cardiology Coding Alert

Question: What is the reimbursement for G0446 and G0447 and which payers cover these services?

New Jersey Subscriber

Answer: Medicare’s national reimbursement rate for G0446 (Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes) is $26.15 in the nonfacility setting and $24.00 in the facility setting.

Medicare’s national rate for G0447 (Face-to-face behavioral counseling for obesity, 15 minutes) is the same at $26.15 in the nonfacility setting and $24.00 in the facility setting.

National rate refers to the rate before applying the geographic adjustment Medicare applies based on locality.

The catch: Medicare covers these codes only for certain provider specialty types. Medicare does not cover these codes for cardiologists. 

To review the specialty types Medicare allows, see www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7636.pdf and www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf.

Private payers may vary on their coverage of these HCPCS codes. But as with Medicare, you will want to check to see whether the plan covers the code only for specific specialties.