Institutional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11)

by  Jared Staheli
July 7th, 2015

For claims with dates of service on and after October 14, 2011, Medicare will allow coverage for annual screening depression in adults, HCPCS G0444 for:

• Rural Health Clinics (RHCs) type of bill (TOB) 71X only – based on the all-inclusive payment rate.

• Federally Qualified Health Centers (FQHCs) TOB 77X only – based on the allinclusive payment rate.

• Outpatient hospitals - Based on Outpatient Prospective Payment System (OPPS) TOB 13X – based on reasonable cost.

• Critical Access Hospitals (CAHs) TOB 85X – based on reasonable cost.

• CAH Method II with revenue codes 096x, 097x, or 098x only - based on 115% of the lesser of the actual charge or the MPFS.

For RHCs and FQHCs, annual screening for depression in adults is not separately payable with another face-to-face encounter on the same day. This does not apply to the Initial Preventive Physical Examination (IPPE), unrelated services denoted with modifier 59, and 77X claims containing Diabetes Self-Management Training (DSMT) and/or Medical Nutrition Therapy (MNT) services. DSMT and MNT apply to FQHC’s only. However, annual screening depression by itself, when rendered as a face-to-face visit with a core practitioner, does constitute an encounter and is paid based on the allinclusive payment rate.

Note: For outpatient hospital settings, as in any other setting, services covered under this NCD must be provided by a primary care provider.

Claims submitted with the annual screening depression HCPCS G0444 code on a TOB other than 13X, 71X, 77X, and 85X will be denied.

Effective for dates of service on and after October 14, 2011, deductible and coinsurance shall not be applied for claims billed for annual depression screening in adults with HCPCS G0444 at the line-level.

References:

Institutional Billing Requirements for Screening for Depression in Adults (Rev. 2431, 10-14-11). (2015, July 7). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/institutional-billing-requirements-for-screening-for-depression-in-adults-rev-2431-10-14-11-27073.html

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