Alcohol Misuse Screening Covered by Medicare

Effective October 14, 2011, Medicare expanded its Preventive Services program to include steps to reduce alcohol misuse.  See table below for reimbursement details.

The National Council on Alcoholism and Drug Dependence is sponsoring April as the month to raise the awareness of alcohol use.   Since alcohol use can range from never to occasional to the far extremes of alcohol abuse and Alcoholism (alcohol dependence), healthcare providers can benefit from various educational tools available to assist in the evaluation of their patients. 

Reviewing up to date statistics on the prevalence of alcohol use are a great place to start.  On the National Institutes of Health website for National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://www.niaaa.nih.gov/alcohol-health you can get find some of the following facts:

1. Of those adult Americans (ages 18 and over)that drank in the past year, 21.9% of       women and 42.3% of men consumed 3 or more drinks.
2. Daily consumption of adult Americans in the last year is 2.45% for women, and 5.78% for men. 
3. In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol1
• .5 ounces of distilled spirits, which is about 40% alcohol

Numerous health conditions can be brought on or exacerbated by alcohol use. 

1. Alcohol interferes with the brain’s communication pathways, disrupting brain function that can lead to mood or behavioral changes, thought processing and physical movement. 
2. High consumption of alcohol either over time or on one instance can cause heart problems like cardiomyopathy, arrhythmias, stroke and high blood pressure. 
3. The liver and pancreas can be affected in a variety of ways by heavy drinking including: steatosis (Fatty liver), alcoholic hepatitis, fibrosis and cirrhosis of the liver, and pancreatitis. 
4. High levels of alcohol consumption can increase risks of developing cancers in areas such as:  mouth, esophagus, throat, liver and breast. 
5. A weakened immune system can make heavy and/or chronic drinkers more susceptible to infections such as pneumonia and tuberculosis.

 Primary Care Physicians should review the following basic Medicare coverage information:

Service	HCPCS Codes	ICD-9 Codes	Coverage	Frequency	Beneficiary Financial Responsibility
Alcohol misuse screening in Primary Care setting	G0442	Contact local Medicare Contractor for guidance.	All Medicare beneficiaries are eligible.	Once per year	Deductible and coinsurance are waived.
Behavioral counseling intervention	G0443	Contact local Medicare Contractor for guidance.	All Medicare beneficiaries are eligible.	Up to four times per year	Deductible and coinsurance are waived.