Contact local Medicare Administrative Contractor (MAC) for guidance
Who Is Covered
All Medicare beneficiaries are eligible for alcohol screening.
Medicare beneficiaries who screen positive (those who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence) are eligible for counseling if:
They are competent and alert at the time that counseling is provided; and
Counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.
Frequency
Medicare covers one alcohol misuse screening per year. If your primary care doctor or
other primary care practitioner determines you’re misusing alcohol, you can get up to
4 brief face-to-face counseling sessions per year (if you’re competent and alert during
counseling). A qualified primary care doctor or other primary care practitioner must
provide the counseling in a primary care setting (like a doctor’s office).
Annually for G0442; or
For those who screen positive, 4 times per year for G0443
Beneficiary Pays
You pay nothing for this screening if the doctor or other qualified health
care provider accepts assignment.