CMS Pub. 100-04, ch. 18, § 180.1

Claims with dates of service on and after October 14, 2011, the Centers for Medicare & Medicaid

Services (CMS) will cover annual alcohol misuse screening (HCPCS code G0442) consisting of

1 screening session, and for those that screen positive, up to 4 brief, face-to-face behavioral

counseling sessions (HCPCS code G0443) per 12-month period for Medicare beneficiaries,

including pregnant women.

Medicare beneficiaries that may be identified as having a need for behavioral counseling sessions

include those:

• Who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet

criteria for alcohol dependence (defined as at least three of the following: tolerance,

withdrawal symptoms, impaired control, preoccupation with acquisition and/or use,

persistent desire or unsuccessful efforts to quit, sustains social, occupational, or

recreational disability, use continues despite adverse consequences); and,

• Who are competent and alert at the time that counseling is provided; and,

• Whose counseling is furnished by qualified primary care physicians or other primary care

practitioners in a primary care setting.

Once a Medicare beneficiary has agreed to behavioral counseling sessions, the counseling

sessions are to be completed based on the 5As approach adopted by the United States Preventive

Services Task Force (USPSTF.) The steps to the 5As approach are listed below.

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior

change goals/methods.

2. Advise: Give clear, specific, and personalized behavior change advice, including information

about personal health harms and benefits.

3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s

interest in and willingness to change the behavior.

4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in

achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental

supports for behavior change, supplemented with adjunctive medical treatments when

appropriate.

5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing

assistance/support and to adjust the treatment plan as needed, including referral to more

intensive or specialized treatment.