Preventive Services

Preventive Services Guide


Intensive Behavioral Therapy for Cardiovascular Disease

CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. CMS has determined that the evidence is adequate to conclude that intensive behavioral therapy for CVD is reasonable and necessary for the prevention or early detection of illness or disability and is comprised of components that are recommended with a grade of A or B by the USPSTF.

Coverage Criteria

  • IBT for CVD is covered annually for all Medicare beneficiaries who are competent and alert at the time counseling is provided
    • At least 11 full months must have passed before next IBT for CVD service is covered
  • Must be furnished by a qualified primary care physician or other primary care practitioner in a primary care setting
  • IBT for aspirin use and health diet must be consistent with the 5A approach
    • Assess
      • Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods
    • Advise
      • Give clear, specific and personalized behavior change advice, including information about personal health harms and benefits
    • Agree
      • Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior
    • 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
    • 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

Components of IBT for CVD

  • Encouraging use of aspirin for CVD prevention when benefits outweigh risks
    • Men aged 45–79, women aged 55–79
  • Screening for high blood pressure
    • Adults aged 18 or older
  • Intensive counseling to promote healthy diet
    • Adults with hyperlipidemia, hypertension, advancing age, other known risk factors for CVD or diet-related chronic disease

HCPCS/CPT Coding

  • G0446: Intensive behavioral therapy to reduce cardiovascular disease risk, individual, face-to-face, annual, 15 minutes

Diagnosis Coding

Who Can Perform?

  • General practice
  • Family practice
  • Internal medicine
  • Obstetrics/gynecology
  • Pediatric medicine
  • Geriatric medicine
  • Certified nurse midwife
  • Nurse practitioner
  • Certified clinical nurse specialist
  • Physician assistant

Applicable Places of Service

  • Physician’s office
  • Outpatient hospital
  • Independent clinic
  • State or local public health clinic

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

Reimbursement

Nonparticipating Providers:

  • Nonparticipating reduction applies
  • Limiting charge provision applies

Common Claim Denials

  • Rendering provider not eligible to perform service
  • Performed in inappropriate or invalid place of service
  • At least 11 months have not passed since last covered IBT for CVD service

Related Content

Reviewed 9/27/2024