HCPCS G0442 is officially defined as "Annual alcohol misuse screening, 5 to 15 minutes." HCPCS G0442 is referenced in 11 tracked payer policy changes from Anthem BCBS, Blue Cross of Idaho, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0442 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
Blue Cross of Idaho updated FQHC billing requirements for Medicare Advantage patients, removing MMCP/IMP billing requirements and clarifying language for Chronic Care Management (CCM), Virtual Communication Services (VCS), Psychiatric Collaborative Care Model (CoCM), and telehealth services. FQHCs must continue using specific revenue codes and HCPCS codes for qualifying services under the CMS Prospective Payment System.
Blue Cross of Idaho revised billing requirements for Rural Health Centers (RHCs) under Medicare Advantage plans, removing MMCP/IMP language from previous policy versions. RHCs must continue using specific Type of Bill 71X with designated revenue codes and CPT/HCPCS codes for qualifying visits under the CMS prospective payment system.
CareSource Indiana Medicaid is offering a $25.00 incentive payment to eligible rendering providers for utilizing four specific behavioral health screening codes (G0444, G0442, 99408, 99409) with qualifying visits from April 1, 2025 through December 31, 2025. This incentive does not reduce existing fee schedule rates and excludes FQHC and RHC providers. Effective July 1, 2025.
Blue Cross of Idaho revised its Medicare Advantage billing policy for Rural Health Clinics in September 2026 to add preventive exam language and update how care coordination, virtual communication services, psychiatric collaborative care, telehealth and vaccines are billed, following CMS coding changes. The policy gives no single effective date for the September 2026 revision, but it lists code-specific dates of January 1, 2026 and October 1, 2026, both now passed. The entry for G0511 reads 'Oct. 1, 25', which is unclear, so confirm that date with Blue Cross of Idaho.
Blue Cross of Idaho's FQHC billing policy for Medicare Advantage claims, with the September 2026 revision that added language on preventive exams. Preventive exams (CPT 99381 through 99387) are billed separately on a CMS-1500 claim, and FQHC qualifying visits need the right type of bill, revenue code and CMS payment HCPCS code, because claims missing any of these are denied and returned for correction. The policy text states no effective date of its own, so confirm the current rules on the payer's site.
Blue Cross of Idaho's billing policy for federally qualified health centers (FQHCs) on Medicare Advantage claims, last revised September 2026 to add preventive exam language. FQHC qualifying visits must carry the right type of bill, revenue code and CMS payment HCPCS code, and claims missing any of these are denied and returned for correction, so the FQHC billing team needs to confirm its claim setup against the current list.
Oregon Health Authority is increasing Medicaid fee-for-service primary care rates by 2%, raising the conversion factor from $27.82 to $28.50. This affects evaluation and management codes, immunization administration codes, and health/behavior assessment codes.
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Fresno, Kings and Madera counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus and Tulare counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
Molina Healthcare of California is reminding providers to implement alcohol and drug use screening, assessment, brief interventions, and referrals to treatment (SABIRT) for Medi-Cal members ages 11 and older. This is an ongoing requirement with specific billing codes and frequency limits that must be followed.
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