(Medicare Claims Processing Manual)

When applying frequency limitations to G0442 screening on the same date of service as G0443 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 screening services: TOB 13X, TOB 85X when the revenue code is not 096X, 097X, or 098X.  CWF shall identify all other claims as professional service claims for screening services.  NOTE: This does not apply to RHCs and FQHCs.  190 - Screening for Depression in Adults (Effective October 14, 2011)  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A. Coverage Requirements   Effective October 14, 2011, the Centers for Medicare & Medicaid Services (CMS) will cover annual screening up to 15 minutes for Medicare beneficiaries in primary care settings that have staff -assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow -up.  Various screening tools are available for screening for depression.  CMS does not identify specific depression screening tools.  Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting.  Screening for depression is non- covered when performed more than one time in a 12 -month period.  The Medicare coinsurance and Part B deductible are waived for this preventive service.   Additional information on this National Coverage Determination (NCD) for Screening for Depression in Adults can be found in Publication 100- 03, NCD Manual, Section 210.9.  190.1 - A/B MAC (B) Billing Requirements  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   Effective October 14, 2011, A/B MACs (B) shall recognize new HCPCS G0444, annual depression screening, 15 minutes.  190.2 - Frequency  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A/B MACs (B) shall pay for annual depression screening, G0444, no more than once in a 12- month period.  NOTE:  11 full months must elapse following the month in which the last annual depression screening took place.   190.3 - Place of Service (POS)  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A/B MACs (B) shall pay for annual depression screening claims, G0444, only when services are provided at the following places of service (POS):   11 - Office  22 - Outpatient Hospital 49 - Independent Clinic  71 - State or Local Public Health Clinic   190.4 - Common Working File (CWF) Edits  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   CWF shall count 11 full months from the month of the prior annual depression screening, G0444, before allowing subsequent payment.  190.5 - Professional Billing Requirements  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A/B MACs (B) shall use the following claim adjustment reason codes (CARCs), remittance advice remark codes (RARCs), group codes, or Medicare Summary Notice (MSN) messages when denying payment for G0444 when reported more than once in a 12- month period.  o CARC 119 -  Benefit maximum for this time period or occurrence has been reached.   o RARC N362 -  The number of days or units of service exceeds our acceptable maximum.   o MSN 20.5 -  These services cannot be paid because your benefits are exhausted as this time.  Spanish Version -  Estos servicios no pueden ser pagados porque sus beneficios se han agotado.   o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.  o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  A/B MACs (B) shall use the following CARCs, RARCs, group codes, or MSNs messages when denying payment for G0444 and POS codes other than: 11 -Office; 22 -Outpatient Hospital; 49 -Independent Clinic; and 71-State or Local Public Health Center.   o CARC 58 -  Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.  Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   o RARC N428 -  Not covered when performed in this place of service.   o MSN 21.25 -  This service was denied because Medicare only covers this service in certain settings.  Spanish Version -  El servicio fue denegado porque Medicare solamente lo cubre en ciertas situaciones."   o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.  o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  190.6 - Institutional Billing Requirements  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   For claims with dates of service on and after October 14, 2011, Medicare will allow coverage for annual screening depression in adults, HCPCS G0444 for:    Rural Health Clinics (RHCs) type of bill (TOB) 71X only -  based on the all -inclusive payment rate.    Federally Qualified Health Centers (FQHCs) TOB 77X only -  based on the all -inclusive payment rate.    Outpatient hospitals -  Based on Outpatient Prospective Payment System (OPPS) TOB 13X -  based on reasonable cost.    Critical Access Hospitals (CAHs) TOB 85X -  based on reasonable cost.    CAH Method II with revenue codes 096x, 097x, or 098x only -  based on 115% of the lesser of the actual charge or the MPFS.   For RHCs and FQHCs, annual screening for depression in adults is not separately payable with another face -to-face encounter on the same day.  This does not apply to the Initial Preventive Physical Examination (IPPE), unrelated services denoted with modifie r 59, and 77X claims containing Diabetes Self -Management Training (DSMT) and/or Medical Nutrition Therapy (MNT) services.  DSMT and MNT apply to FQHCs only.  However, annual screening depression by itself, when rendered as a face -to-face visit with a core  practitioner, does constitute an encounter and is paid based on the all -inclusive payment rate.   Note:  For outpatient hospital settings, as in any other setting, services covered under this NCD must be provided by a primary care provider.   Claims submitted with the annual screening depression HCPCS G0444 code on a TOB other than 13X, 71X, 77X, and 85X will be denied.  Effective for dates of service on and after October 14, 2011, deductible and coinsurance shall not be applied for claims billed for annual depression screening in adults with HCPCS G0444 at the line -level.   190.7 - CARCs, RARCs, Group Codes, and MSN Messages  (Rev. 2431, Issued: 03- 23-12, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A/B MACs (A) and (B) shall use the appropriate CARC, RARC, group codes, or MSN messages when denying payment for annual depression screening in adults:    For RHCs and FQHCs when screening for depression, HCPCS code G0444, with another encounter/visit with the same line -item date of service, use group code CO and :   o CARC 97 -  The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.  Note:  Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) if present.    Denying claims containing HCPCS code G0444, submitted on a TOB other than 13X, 71X, 77X, and 85X:   o MSN 21.25 -  This service was denied because Medicare only covers this service in certain settings.   o CARC 170 -  Payment is denied when performed/billed by this type of provider.  Note:  Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   o RARC N428 -  Not covered when performed in this place of service .  o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.  o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.   Denying claims containing HCPCS code G0444, depression screening in adults, more than once in a 12-month period:   o MSN 20.5 -  These services cannot be paid because your benefits are exhausted at this time.  o CARC 119 -  Benefit maximum for this period or occurrence has been reached.   o RARC N362 -  The number of days or units of service exceeds our acceptable maximum.   o Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a claim is received with a GA modifier indicating a signed ABN is on file.  o Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.  200 - Intensive Behavioral Therapy for Obesity (Effective November 29, 2011)  (Rev. 2421, Issued: 03- 07-12, Effective: 11 -29-11, Implementation: 03- 06-12, for non -shared system edits, 07- 02-12 for shared system edits, CWF provider screen .HICR, and MCSDT changes)   The United States Preventive Services Task Force (USPSTF) found good evidence that body mass index (BMI) is a reliable and valid indicator for identifying adults at increased risk for mortality and morbidity due to overweight and obesity.  It also good evi dence that high intensity counseling combined with behavioral interventions in obese adults (as defined by a BMI 30 kg/m2) produces modest, sustained weight loss.   200.1 - Policy  (Rev. 3329, Issued: 08- 14-15, Effective: 01 -01-12, Implementation: 09- 14-15)