- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Alcohol Misuse and Counseling
Table of Contents
- Alcohol Misuse and Counseling
- Two-Part Benefit
- Cost Sharing
- Reimbursement
- Nonparticipating Providers
- Common Claim Denial Reasons
- Related Content
Alcohol Misuse and Counseling
The USPSTF recommended statement definitions:
- Risky, hazardous, or harmful drinking which places an individual at risk for future problems with alcohol consumption. Alcohol consumption becomes hazardous or risky when consuming:
- greater than seven drinks per week, or greater than three drinks per occasion for women and persons 65 years and older, and
- greater than 14 drinks per week, or greater than four drinks per occasion for men.
Alcohol dependence is defined as having at least three of the following:
- Tolerance
- Withdrawal symptoms
- Impaired control
- Preoccupations with acquisition and/or use
- Persistent desire or unsuccessful efforts to quit
- Sustained social, occupational or recreational disability
- Continuous use despite adverse consequences
Harmful drinking includes physical, social or psychological harm from alcohol use, but does not meet criteria for dependence.
Two-Part Benefit
- Annual screening, all beneficiaries
- G0442: Annual alcohol misuse screening, 15 minutes
- Annually
- G0442: Annual alcohol misuse screening, 15 minutes
- Behavioral counseling intervention, covered when criteria met
- G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- For those who screen positive, covered four times per year
- Covered when patient screened positive for alcohol misuse, but not alcohol dependence
- Each behavioral counseling session intervention must be consistent with the five “A” approach adopted by the USPSTF; assess, advise, agree, assist, arrange
- Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods
- Advise: Give clear, specific and personalized behavior change advice, including information about personal health harms and benefits
- Agree: Collaboratively select appropriate treatment goals and methods based on patient’s interest in and willingness to change the behavior
- Assist: Using behavior change techniques (self-help and/or counseling), aid patient in achieving agreed-upon goals by acquiring skills, confidence and social/environmental supports for behavior change, supplement with adjunctive medical treatments when appropriate
- Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support, adjust treatment plan as needed to include referral to more intensive or specialized treatment
- Up to four brief, face-to-face behavioral counseling interventions covered per year
- Patient must be competent and alert during counseling
- Counseling furnished by qualified primary care physician or other primary care practitioner in primary care setting
- G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
- Diagnosis code, for individual Change Requests and coding translations for ICD-10
- No specific alcohol misuse screening tool required (discretion of practitioner)
- Both screening and counseling can be covered on same date of service (except RHCs and FQHCs)
- No more than one G0443 service can be paid for per date of service
- No payment for additional time spent in screening or counseling
- No start/stop times required in documentation
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denial Reasons
- Covered alcohol misuse screening in last 12 months
- Received behavioral counseling interventions to reduce alcohol misuse but no claims history in previous 12 months of alcohol misuse screening
- More than four covered behavioral counseling interventions to reduce alcohol misuse visits in last 12 months
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 180
- CMS IOM Publication 100-03 Medicare National Coverage Determinations Manual, Part 4, Section 210.8
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/12/2023