CMS clarifies billing and coding requirements for preventive services

Revenue integrity professionals should take note of recent updates to CMS’ Medicare Preventive Services educational tool. The agency added billing and coding guidance for various preventive services, including alcohol misuse screening and counseling, HIV Pre-Exposure Prophylaxis (PrEP), and more.

CMS added information on Healthcare Common Procedure Coding System (HCPCS) code G0560, which is used to report safety planning interventions performed by the billing provider in a variety of settings, billed in 20-minute increments, to several service pages. The agency also included billing instructions for HCPCS code G0544, which is used to report follow-up phone contact interventions made after discharge from the emergency department for behavioral health or other crisis encounter. This service should be billed as a bundled service and describe four calls in a calendar month. Read MLN Matters 13887 for more information on these codes.

CMS also provided information on the following:

• ICD-10 code Z72.0 (effective October 1, 2024), used to bill for counseling to prevent tobacco use
• HCPCS code J0799, which organizations are to use to bill for lenacapavir for HIV PrEP until September 30, 2025
• HCPCS code G0567 (effective June 27, 2024), used to report infectious agent detection by nucleic acid; hepatitis C, screening, amplified probe technique

Along with these updates, CMS added guidance to several service pages on billing office and outpatient (O/O) evaluation and management (E/M) visit complexity add-on HCPCS code G2211 with Part B preventive services. As of January 1, revenue integrity professionals can report code G2211 and E/M services billed with modifier 25 when performed on the same day as an annual wellness visit (HCPCS codes G0438/G0439), vaccine administration, or any Part B preventive services in the O/O setting, aside from glaucoma screenings.

Revenue integrity professionals can find more information on HCPCS code G2211 in MLN Matters 13473. Keep an eye out for additional billing and coding updates related to preventive services in the 2026 Medicare Physician Fee Schedule final rule, which is expected to be published this fall.