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

ICD-10
- CMS ICD-10 webpage

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

MPFS: Fee Schedule Lookup

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