What is the Description of HCPCS G0446?
HCPCS code G0446 is for “annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes.”
What is Intensive Behavioral Therapy for Cardiovascular Disease?
Intensive Behavioral Therapy (IBT) for cardiovascular disease is a preventive benefit for all Medicare beneficiaries. The service involves:
- Encouraging aspirin use for CVD risk factor reduction, when appropriate
- Screening for high blood pressure
- Counseling on a healthy diet
Who Can Bill IBT for Cardiovascular Disease?
IBT can be furnished by a primary care physician as well as other primary care practitioners. This includes:
- General practice physicians
- Family practice physicians
- Internal medicine physicians
- Obstetrics-gynecology physicians
- Geriatrics physicians
- Nurse practitioners
- Certified clinical nurse specialists
- Physician assistants
This benefit can also be provided by auxiliary personnel, including dietitians, if billed “incident to” one of the above providers. Be aware, CMS has specific guidelines for billing incident to that should be followed in order to be compliant.
Having auxiliary personnel render the service is generally recommended for a variety of reasons. Physicians have limited training in nutrition counseling as well as limited time. IBT has a lower pay rate than other medical services, so using a provider that costs less, makes it a more financially viable service.
Medicare will only pay for IBT when it is provided in a primary care setting, which can include the following places of service (POS):
- Office – 11
- Outpatient Hospital – 22
- Independent Clinic – 49
- Public Health Clinic – 71
How Many Sessions of IBT are Covered?
Medicare will pay for one 15-minute unit of IBT, for cardiovascular disease, per year. Specifically, per CMS, “11 full months must elapse following the month in which the last IBT for CVD took place.”
This differs greatly from IBT for obesity in which Medicare covers up to 22 units per year.
Do Private Insurance Companies Cover IBT?
IBT for cardiovascular disease is a specific Medicare Part B benefit available to people that have Original Medicare and Medicare Advantage Plans. Other payers and plans may or may not cover this service.
Many commercial plans have medical nutrition therapy (MNT) coverage for diagnoses such as hypertension, hyperlipidemia and obesity, so it may make more sense for dietitians to bill with these procedure codes instead, if appropriate.
The MNT codes have higher reimbursement rates, so using CPT codes 97802, 97803 and 97804, is advisable. These codes can be billed directly under the dietitian’s NPI number, rather than billing incident to another provider.
Reimbursement Rates
Medicare fee schedules are public information, which can be found using the CMS Search the Physician Schedule Look-Up Tool.
If a physician is the supervising provider, 100% of the fee schedule will be paid. If an advanced practice practitioner, such as a nurse practioner, is the supervising provider, only 85% of the fee schedule will be paid.
Since IBT is a preventive visit, Medicare will pay the full amount owed, with no patient responsibility.
In Summary
HCPCS G0446 is to be used when Intensive Behavior Therapy for cardiovascular disease is provided. This is a preventive benefit available to people with Medicare Part B.
IBT needs to be provided in a primary care setting. If auxiliary personnel are providing the service, it will need to be billed incident to a physician or other primary care provider.
References:
Intensive Behavioral Therapy for Cardiovascular Disease (210.11)