Billing and documentation criteria for preventive services
| Service | CPT code | RVUs | Time (minutes) | Recommended diagnosis | Required interval | Other requirements |
|---|---|---|---|---|---|---|
| Cognitive assessment | 99483 | 3.44 | None | None | 180 days | Cognitive Assessment Template Not the same cognitive assessment described in the AWV |
| Advance care planning | 99497 99498 | 1.5 1.40 | 15–45 > 45 | None | None | Document discussion, outcomes, and signed forms |
| Depression screening | G0444 | 0.18 | ≤ 15 | 713.31: Encounter for screening for depression | 365 days | |
| Smoking cessation | 99406 99407 | 0.24 0.50 | 3–10 > 10 | Severala | ||
| Alcohol screening | G0442 | 0.18 | > 15 | Any alcohol use code | 365 days | Patient must be having adverse effects from use |
| Alcohol counseling | G0443 | 0.45 | > 15 | Any alcohol use code | 4 sessions per year | Patient must have positive alcohol screen |
| STD counseling | G0445 | 0.45 | > 30 | Severalb | 180 days | Document education and skills provided |
| Cardio-vascular counseling | G0446 | 0.45 | > 15 | 713.6: Screening for cardiovascular disease | 365 days | Must include intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardio-vascular and diet-related chronic diseases If a patient has a current diagnosis of hyperlipidemia and/or hypertension, the diagnosis codes for these diseases should be used instead of Z13.6; screening codes cannot be used if the patient already has a confirmed diagnosis |
| Weight counseling | G0447 | 0.45 | > 15 | BMI > 30.0 kg/m2 and weight-related diagnosis must be documented | Month 1: weekly Months 2–6: biweekly Monthly thereafter | Goal-oriented behavior |
↵a For example, F17.210: Nicotine dependence, cigarettes, uncomplicated; F17.220: Nicotine dependence, chewing tobacco, uncomplicated; Z87.891: Personal history of nicotine dependence.
↵b For example, Z11.3: Encounter for screening for sexually transmitted infection; Z11.59: Encounter for screening for other viral disease; Z72.89: Other problems related to lifestyle; Z72.51: High-risk heterosexual behavior; Z72.52: High-risk homosexual behavior; Z72.53: High-risk bisexual behavior.
For detailed information see: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.