Are you getting paid for Alcohol Screening and Counseling?

If you are a primary care physician providing these services in your practice and not being compensated for them keep reading to see how we can change that for you. First you should know how this impacts you financially. The alcohol screen and counsel may be billed at the same time as a medically necessary exam. Payment for these services is not high, the RVU’s are 0.51 for the Alcohol Screen and 0.74 for the Alcohol Counseling code. This translates to $17.36 and $25.19 respectively. Note that you must screen prior to billing for counseling or your counseling claims will be denied.

This benefit provides for one annual screening G0442, 0.51 RVU’s or $17.36, and four G0443, 0.74 RVU’s or $25.19 Alcohol Counseling in a 12 month period. Your initial billing for these services might look like the following example:

99213-25 + G0442 + G0443, note that this example includes a medical office visit. OR
G0442 + G0443, note that this patient came in for alcohol screen and counsel only.

Your second visit might look like the following example:

99213-25 + G0443, note that your NOT billing the alcohol screen again. OR
G0443, note that this patient came in for alcohol counseling only.

Keep in mind that 11 months must pass before you can bill G0442 again for the same patient. Note that you cannot bill these services on the same day as the IPPE, Welcome to Medicare physical. Note that these services are NOT subject to deductibles or coinsurances. And lastly be advised that your documentation reflects time spent as these codes are time based, and that your counseling for alcohol misuse is based on the five A’s (Assess, Advise, agree, Assist, and Arrange).

Now lets get started, add these two codes to your EHR systems and encounter forms and start using them. If you are providing this service already, stop leaving money on the table and start getting paid for everything you do.

We are here to help you, feel free to give us a call about this or if you need help with any other billing aspects of your practice, please call us toll free at 1.877.666.5279. We are always happy to help and you are never under any obligation!