## **What is HCPCS code G0446?**
HCPCS code G0446 is a Medicare-specific code for annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. This service, which is considered a CVD risk reduction visit, is intended to reduce CVD risk factors through individual, intensive behavioral counseling.
The therapy must be provided by a qualified primary care practitioner (PCP) in a primary care setting. This includes qualified primary care physicians (General Practice, Family Practice, Internal Medicine), Nurse Practitioners (NPs), Physician Assistants (PAs), Certified Clinical Nurse Specialists (CNSs), and other primary care practitioners who are qualified.
There are three components in the therapy itself:
- Encouraging aspirin use for the primary prevention of CVD in men ages 45-79 and women ages 55-79 when the benefits outweigh the risks.
- Screening for high blood pressure (adults age 18 and older)
- Intensive behavioral counseling interventions to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors.
## **HCPCS code G0446 documentation requirements**
Proper documentation for G0446 includes:
- A confirmed diagnosis or risk factors for CVD.
- The record must clearly indicate that intensive behavioral counseling for CVD was performed.
- The service must be provided by a qualified primary care practitioner in an appropriate primary care setting (e.g., physician's office, outpatient hospital, independent clinic, or state/local public health clinic). A signed encounter note must be provided as proof.
- The patient must be a Medicare beneficiary, competent, and alert at the time of the counseling. Note that the annual eligibility is confirmed.
- The documentation should reflect that the three components of the therapy (aspirin use advice, blood pressure screening, and healthy diet counseling) were addressed.
- The service is defined as 15 minutes. Start/stop times of each session (for time validation).
Documentation must show that the interaction was face-to-face, personalized, and focused on behavior modification specific to cardiovascular health.
## **G0446 billing requirements**
G0446 may be billed once per 12-month period and must:
- Be provided in a primary care setting.
- Be delivered by a qualified provider (e.g., physician, NP, PA).
- Not to be billed concurrently with other preventive counseling codes.
- Be provided to a Medicare beneficiary with risk factors for CVD.
- Have the needed appended modifiers depending on the situation and guidelines of the payer
No patient cost-sharing is required for this service under Medicare preventive coverage guidelines.
## **Other relevant codes**
- G0447: Behavioral counseling for obesity, 15 minutes
- 99401: Preventive medicine counseling (individual, ~15 minutes)
- 99406: Smoking cessation counseling, 3–10 minutes
- 99407: Smoking cessation counseling, >10 minutes
Frequently asked questions
