If you are already counseling for smoking cessation in your practice, you are doing the work, so get paid for it. Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $28.96. The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $15.70.
Full Answer
How much does smoking cessation counseling cost with Medicare?
Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $28.96. The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $15.70.
What are the CPT codes for billing for smoking cessation services?
The CPT codes are listed below for billing for smoking cessation: 99406 - Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 - Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes modifier 25 may be appropriate to append to the primary E/M visit code.
Is 99407 an add-on code?
99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling. Don’t have a login?
What is the 3 to 10 minute counseling code for Medicare?
The 3 to 10 minute counseling code, 99406, reimburses $15.70. These are national reimbursement amounts, your local Medicare payments may vary.
Does Medicare pay for CPT 99407?
Smoking Cessation Counseling Codes 99406 and 99407 Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
Does CPT code 99407 need a modifier?
Magnolia Health (MH) indicates that 99406 and 99407 are reimbursed with no modifier or diagnosis limitations. The codes are payable on the physician side, but are not covered for outpatient facility claims.
Can you Bill 99406 to Medicare?
The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year.
What is procedure code 99407?
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling. Code.
Can 99406 and 99407 be billed together?
Description of CPT code 99406 & 99407 CPT code 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling.
What is the CPT code for smoking cessation for Medicare?
5878.4 Medicare systems shall revise all current edits defining the appropriate revenue codes and types of bill for reporting Smoking and Tobacco-Use Cessation Counseling services to include the new CPT codes 99406 and 99407.
Can 99406 be billed as telehealth?
Medicare patients can access telehealth from their homes (also known as originating site requirements). Previously, patients could only access telehealth from a provider office. Tobacco cessation counseling (CPT codes: 99406 and 99407) can be conducted via audio-only interaction.
Can 90471 and 99406 be billed together?
If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service.
Can 99406 be billed inpatient?
CPT code 99406, 99407 , C9801, C9802 – Tobacco Use Cessation Counseling. Medicare covers counseling for tobacco cessation for outpatients and for inpatients. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patient's hospital stay. Medicare covers 2 cessation attempts per year ...
How do I bill a CCM code?
Any cost incurred as a result of the provision of FQHC services, including care management, is a reportable cost and must be included in the Medicare cost report. CCM should be reported on 837-I with revenue code 052x and corresponding HCPCS (e.g., CPT) code. time per calendar month.
How many times can you bill 99497?
Are there limits on how often I can bill CPT codes 99497 and 99498? Per CPT, there are no limits on the number of times ACP can be reported for a given beneficiary in a given time period. Likewise, the Centers for Medicare & Medicaid Services has not established any frequency limits.
What is the diagnosis code for smoking cessation?
Z71. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z71.
What is the CPT code for E/M counseling?
CMS does not currently have specific training requirements, but may in the future. The counseling must be provided face-to-face with the patient. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). The diagnosis code should reflect the condition ...
Who is covered by Medicare Part B?
These individuals who do not have signs or symptoms of tobacco-related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations.
What is the procedure code for smoking cessation?
Procedure code description. • 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. Medicare covers counseling for tobacco cessation for outpatients and for inpatients. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patient’s hospital stay.
How many cessation attempts per year for Medicare?
Inpatients are covered only if counseling for tobacco use is not the primary reason for the patient’s hospital stay. Medicare covers 2 cessation attempts per year. The counseling during an E/M service must be either intermediate or intensive. Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. ...
How long is a 99406?
• 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes#N# • 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
What is the CPT code for E/M counseling?
CMS does not currently have specific training requirements, but may in the future. The counseling must be provided face-to-face with the patient. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). The diagnosis code should reflect the condition ...
How many cessation attempts per year for Medicare?
Inpatients are covered only if counseling for tobacco use is not the primary reason for the patient’s hospital stay. Medicare covers 2 cessation attempts per year. The counseling during an E/M service must be either intermediate or intensive. Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. ...
What is a diagnosis code for tobacco?
The diagnosis code should reflect the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.
What is the code for smoking cessation?
There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.
Is 99407 an add-on code?
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling. Code.
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