US · guidance
CMS Pub. 100-04, ch. 18, § 200.5
Common Working File (CWF) Edits
When applying frequency, CWF shall count 22 counseling sessions of any of G0473 and/or
G0447 (for a total of no more than 22 sessions in the same 12-month period) along with 1 ICD-9-
CM code from V85.30-V85.39 or V85.41-V85.45 in a 12-month period, or if ICD-10 is
applicable with 1 ICD-10-CM code from Z68.30-Z68.39 or Z68.41-Z68.45. When applying
frequency limitations to G0473 or G0447 counseling CWF shall allow both a claim for the
professional service and a claim for a facility fee. CWF shall identify the following institutional
claims as facility fee claims for this service: TOB 13X, TOB 85X when the revenue code is not
096X, 097X, or 098X. CWF shall identify all other claims as professional service claims.
History
(Rev. 3329, Issued: 08-14-15, Effective: 01-01-12, Implementation: 09-14-15)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3f3da49c59fdb34426b8c77af3ca9c82a1ddba8c78ee523e44ded589c2f729e7
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