Alcohol Awareness and Screening

According to the Centers for Disease Control (CDC), alcohol is the most used substance in the United States among people above 12 years of age.

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers and health systems screen for alcohol use. Clinicians should utilize a screening tool to identify adults who drink excessively and offer behavioral counseling when warranted. Screening resources are available from the National Institute on Alcohol Abuse and Alcoholism. Various screening tools are available; however, the specific tool is at the discretion of the provider.

According to National Coverage Determination (NCD) 210.8, the Centers for Medicaid and Medicare Services (CMS) will cover annual alcohol screenings in primary care. Any person that screens positive, may be offered up to four brief face-to-face behavioral counseling interventions per year, including pregnant women who:

• Misuse alcohol, but do not meet criteria for alcohol dependence, which is defined as at least three of the following:
  • Tolerance
  • Withdrawal symptoms
  • Impaired control
  • Preoccupation with acquisition and/or use
  • Persistent desire or unsuccessful efforts to quit
  • Sustains social, occupational or recreational disability
  • Use continues despite adverse consequences
• Are competent and alert at the time that counseling is provided
• Get counseling furnished by qualified primary care physicians or other primary care practitioners in a primary care setting

Each of the behavioral counseling interventions should be consistent with the five A’s approach that has been adopted by the USPSTF to describe such services. They are:

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
2. Advise: Give clear, specific and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
4. 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.
5. 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.

Alcohol Misuse Screening & Counseling

Healthcare Common Procedure Coding System Codes

• G0442: Annual alcohol misuse screening, 5 to 15 minutes
• G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

Frequency

• Annually (G0442 screening)
• If they screen positive for misuse, four face-to-face counseling sessions per year (G0443 counseling)
• Don’t do more than one intervention per day

Patient Pays

• No copayment, coinsurance or deductible

References and Resources

• CDC Alcohol Use and Your Health
• CDC Alcohol Use Preventing Excessive Alcohol Use with Proven Strategies
• CMS Manual System, Pub. 100-03 Medicare National Coverage Determinations: Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (PDF)
• CMS National Coverage Determination (NCD) 210.8 Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse
• MLN Booklet: Substance Use Screenings and Treatment (PDF)
• MLN Fact Sheet: Checking Medicare Eligibility (PDF)
• MLN Educational Tool: Medicare Preventive Services
• Palmetto GBA
• U.S. Preventive Services Task Force

For Your Patients

• Alcohol Misuse Screenings and Counseling
• Mental Health and Substance Use Disorders