The CPT codes for smoking cessation (99406 and 99407) are used for all payers for patients who are symptomatic as a result of smoking. However, there are frequency limits for 99406 and 99407 by patient, not provider. CMS
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services, previously known as the Health Care Financing Administration, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state government…
Does Medicare cover smoking cessation therapy?
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. The CPT codes are listed below for billing for smoking cessation:
Does Medicare cover reimbursement for counseling?
Reimbursement may be possible if you bill the patient’s insurance company correctly. 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.
Is smoking cessation counseling reimbursable under E&M code 99381?
If the physician performs a comprehensive preventative medicine evaluation for new patients (99381-99387) or established patients (99391-99397), the smoking cessation counseling is included within the scope of the service. Use of modifier 25 is required on the E&M code to identify smoking cessation counseling as a separately reimbursable service.
How often can 99406 be billed?
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.
Does Medicare pay for code 99406?
According to the Medicare Preventive Services guide, Medicare suggests the use of codes 99406 and 99407. A notable change as of October 1, 2016 is that the copayment/coinsurance as well as the deductible for 99406 and 99407 are now waived. The Medicare beneficiary has a zero dollar out-of-pocket liability.
What DX code covers 99406?
CPT code 99406 is used to report for smoking and tobacco cessation counseling requiring three to 10 minutes of time and CPT code 99407 for counseling requiring more than ten minutes.
Does CPT 99406 require 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 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 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 ...
Is 99406 considered an E M code?
Smoking cessation (99406 and 99407) services were developed as E/M services and may be reported with the E/M services 99201-99205 and 99211-99215.
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.
What ICD-10 code to use 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.
Who can bill CPT 99406?
Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation.
What does CPT code 99406 mean?
CPT® Code 99406 - Behavior Change Interventions, Individual Services - Codify by AAPC. CPT. Evaluation and Management Services. Preventive Medicine Services. Counseling Risk Factor Reduction and Behavior Change Intervention.
Can 99406 and 99396 be billed together?
So how many people know that, at least as far as the AMA is concerned, you can bill a 99396 and a 99406 (smoking cessation code) at the same session? While tables such as CCI exist, there are many combinations that you might not think to bill together, or that the language of the codes seems to steer you away from.
What is Medicare denied for 99406?
Medicare denied all 99406 ( Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) codes with my e/m code. I stated the diagnosis code
How many cessation codes does Medicare pay?
Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.
How many weight management sessions does Medicare cover?
Also you can check the payer's billing regulations because it may need pre-authorization and most payers only covers 6 weight management sessions a year. Ok I hope this information helps you. Lady T. M.
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
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 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 attempts to quit smoking per year?
Medicare will allow two smoking cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive sessions. A total of eight sessions are covered in a 12-month period. However, these limits do not apply to Paramount members as they are allowed an unlimited number of visits.
How many visits does Optum have?
Optum will align reimbursement with Medicare including up to 2 attempts of up to 4 sessions each for a total of up to 8 face-toface visits during a 12-month period for individuals who use tobacco – regardless of whether there are signs or symptoms of tobacco-related disease. These visits must be provided by a qualified health care provider.
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.
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. ...
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.
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 ...
