by Jared Staheli
July 7th, 2015
For claims with dates of service on and after October 14, 2011, CMS will allow coverage for annual alcohol misuse screening, 15 minutes, G0442, and behavioral counseling for alcohol misuse, 15 minutes, G0443, only when services are submitted by the following provider specialties found on the provider’s enrollment record:
01 - General Practice
08 - Family Practice
11 - Internal Medicine
16 - Obstetrics/Gynecology
37 - Pediatric Medicine
38 - Geriatric Medicine
42 – Certified Nurse-Midwife
50 - Nurse Practitioner
89 - Certified Clinical Nurse Specialist
97 - Physician Assistant
Any claims that are not submitted from one of the provider specialty types noted above will be denied. For claims with dates of service on and after October 14, 2011, CMS will allow coverage for annual alcohol misuse screening, 15 minutes, G0442, and behavioral counseling for alcohol misuse, 15 minutes, G0443, only when submitted with one of the following place of service (POS) codes:
11 - Physician’s Office
22 - Outpatient Hospital
49 - Independent Clinic
71 - State or local public health clinic or
Any claims that are not submitted with one of the POS codes noted above will be denied.
The alcohol screening/counseling services are payable with another encounter/visit on the same day. This does not apply for IPPE.
References: