Cardiovascular Disease and Intensive Behavioral Therapy

This Electronic Comparative Billing Report (eCBR) focuses on primary care physicians and practitioners (PCPs) who care for Medicare beneficiaries. Using claims submitted over multiple years, Palmetto GBA has identified that many PCPs are not reporting the CPT codes associated with the performance of the Annual Wellness Visit (AWV) or the Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) for eligible Medicare beneficiaries. Medicare contractors pay for these preventive services based on coverage and reimbursement guidelines established by the Centers for Medicare & Medicaid Services (CMS). Palmetto GBA is launching a project to better understand and ultimately help improve the performance and reporting of these services. This article shares the baseline results of our claims analysis on a jurisdictional and state level and provides access to individual practice-level information. Our goal, over the next 12 months, is to raise awareness of these covered services and increase the appropriate utilization of the respective HCPCs. 

Cardiovascular disease (CVD) is the leading cause of mortality in the United States. CVD, which comprises hypertension, coronary heart disease (such as myocardial infarction and angina pectoris), heart failure and stroke, is also the leading cause of hospitalizations. Although the overall adjusted mortality rate from heart disease has declined over the past decade, opportunities for improvement still exist.

CMS has determined that the evidence is adequate to conclude that Intensive Behavioral Therapy (IBT) for CVD is reasonable and necessary for the prevention or early detection of illness or disability, and is appropriate for individuals entitled to benefits under Medicare Part A or enrolled under Medicare Part B, and consists of components that are recommended with a grade of A or B by the U.S. Preventive Services Task Force (USPSTF). Components of the AWV also include preventive services aimed at primary and secondary prevention of CVD, so the performance of either the IBT for CVD service (HCPCS code G0446) or the AWV will count towards the goal of increasing the appropriate utilization of evidence-based preventive services.

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Coverage and Documentation Requirements
HCPCS code G0446 is used to report IBT for CVD services (annual face-to-face intensive behavioral therapy for cardiovascular disease). These services are also included as components of the Medicare Annual Wellness Visit. HCPCS code G0446 is only paid annually when services are provided at the following place of service (POS).

• 11 – Office
• 22 – Outpatient Hospital
• 49 – Independent Clinic
• 71 – State or Local Public Health Clinic

Methods
The metrics reviewed in this report are the current rates for IBT for CVD and Annual Wellness Visit (AWV) screening for each provider compared to their own baseline rates and their individual target rates. This report is an analysis of Medicare Part B claims extracted from the Palmetto GBA data warehouse. For the purposes of this CBR, the baseline rate is defined as the HCPCs reporting rates for a given provider from October 2019 to September 2020 using claims data for that provider’s established patients. The target rate is the desired growth of that baseline rate over the 12-month period ending September 2021. The analysis shows the provider’s current utilization rates for the IBT for CVD and AWV preventive services alongside their baseline and target rate for each.