Summary & Overview
HCPCS G0445: High-Intensity STI Prevention Counseling, 30 Minutes
HCPCS Level II code G0445 covers a 30-minute, face-to-face, individual high-intensity behavioral counseling session focused on preventing sexually transmitted infections. The service includes education, skills training, and guidance to support behavioral change and is billable semi-annually per patient. This preventive intervention is relevant to primary care, sexual health, and outpatient behavioral health settings and aligns with public health efforts to reduce STI incidence nationally.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage patterns and common billing considerations across these payers, clinical context for when the service is appropriate, and operational notes on service delivery and coding. The publication also highlights national policy and reimbursement trends affecting preventive counseling for STIs and provides benchmark context where available.
This summary is intended for billing managers, clinicians involved in preventive and sexual health services, and health policy analysts seeking concise guidance about the code's purpose, typical settings, and payer landscape. Data not available in the input are noted where applicable in the full document.
Billing Code Overview
HCPCS Level II code G0445 describes high intensity behavioral counseling to prevent sexually transmitted infection. The service is a face-to-face, individual counseling session of approximately 30 minutes, delivered semi-annually. The counseling includes education, skills training, and guidance on how to change sexual behavior aimed at reducing STI risk.
Service Type: Behavioral counseling / Preventive counseling
Typical Site of Service: Outpatient clinic or office-based setting, including primary care and sexual health clinics
Clinical & Coding Specifications
Clinical Context
A 24-year-old sexually active patient presents to a primary care clinic for preventive care and expresses concern about sexually transmitted infection (STI) risk after a new sexual partner. The clinician schedules a face-to-face, individual high-intensity behavioral counseling visit lasting approximately 30 minutes for STI prevention. The visit is conducted in an outpatient office exam room and includes a focused risk assessment, education about condom use and safer-sex practices, skills training (demonstration and practice of condom application using models), motivational interviewing to elicit behavior change, and development of a personalized risk-reduction plan. Documentation includes duration (30 minutes), counseling content, patient participation, and any materials provided. The service is performed semi-annually per coverage rules, and may be delivered by a primary care physician, nurse practitioner, physician assistant, or a licensed behavioral health clinician trained in sexual risk-reduction counseling. Typical workflow: patient check-in and vitals; brief risk screening; timed 30-minute counseling session billed as G0445; documentation of counseling elements, time, and follow-up plan; scheduling of STI testing or referral as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure |