EmblemHealth Preventive Care/Screening Services Coverage

Date Issued: 7/15/2016

EmblemHealth covers the following services in accordance with CMS Guidelines and requirements under the Affordable Care Act: HCPCS codes G0442, G0443, G0444, G0445, G0446 and G0447. In order to be reimbursed as a separately identifiable preventive service, Modifier 25 must be appended to HCPCS codes G0442 - G0447 when reported with an unrelated Evaluation and Management (E/M) service, in accordance with National Correct Coding Initiatives (NCCI) policies.

Frequency limits are as follows:
G0442 - Annual alcohol misuse screening, 15 minutes, is covered once in a 12-month period.

G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes, is covered no more than four times in a 12-month period.

G0444 - Annual depression screening, 15 minutes, is covered once in a 12-month period.

G0445 - Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training & guidance on how to change sexual behavior, is covered twice in a 12-month period.

G0446 - Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes, is covered once in a 12-month period.

G0447 - Face-to-face behavioral counseling for obesity, 15 minutes, is covered up to a total of three (3) hours in a 12-month period.

For more information, view the EmblemHealth Preventive Care/Screening Services table.