Smoking cessation coding, 99406 and 99407 Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients about stopping tobacco use. Medicare waives the co-payment/co-insurance and deductible for this service. Private insurers can set their own policies and payments. CPT ® codes for Smoking Cessation
What is the smoking cessation counseling code for Medicare?
Smoking Cessation Counseling Codes 99406 and 99407 Reimbursement may be possible if you bill the patient’s insurance company correctly. Medicare covers 2 cessation attempts per 12-month period.
What is the Medicare CPT code for tobacco use?
According to the Medicare Preventive Services guide, Medicare suggests the use of codes 99406 and 99407. Both symptomatic and asymptomatic patients are covered for care if they: • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease • Are competent and alert at the time of counseling coding reference
Does Medicaid cover tobacco cessation services?
Both coinsurance and deductible are waived. Reference CPT codes for asymptomatic patients. Many states offer some payment for individual tobacco cessation and treatment counseling for Medicaid patients. For example, the ACA requires states to expand Medicaid coverage of cessation services for pregnant women.
How do I Bill for smoking cessation?
Check with your local Medicare carrier or private insurance company for their rules and requirements before billing for smoking cessation. The documentation in the medical record must support the billing of the cessation code.
How long does it take to get tobacco cessation counseling?
What is HCPCS coding?
What is the F17 code?
What is CPT medical?
What is the ICD-10 code used for?
Is tobacco use covered by Medicare?
Does the Affordable Care Act cover tobacco?
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What is the CPT code for smoking cessation for Medicare?
99406 and 99407Smoking 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.
What ICD-10 code to use for smoking cessation?
F17. 211 Nicotine dependence, cigarettes, in remission.
Is there a separate Medicare G code for smoking cessations?
CMS has advised its Medicare contractors to replace code G0436 with CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and replace code G0437 with CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 ...
What is the diagnosis code for tobacco use?
specifically, in ICD-9, providers commonly used diagnosis code 305.1 (tobacco use disorder) or V15. 82 (history of tobacco use) depending on the status of the patient as a current or former tobacco user.
Can you bill 99406 with G0439?
In addition, the following services can also now be billed when using audio only: Advance Care Planning (CPT 99497, 99498) Annual Wellness Visits (HCPCS G0438, G0439) Smoking Cessation Services (CPT 99406, 99407)
Do you need modifier 25 with 99406?
If billed alone, 99406 and 99407 are reimbursed. When billed with another evaluation and management code, the codes will bundle to a single fee. To allow payment in this circumstance, providers should append a “25” modifier for 99406 or 99407 codes.
What is the ICD 10 code for nicotine dependence?
ICD-10 code F17. 200 for Nicotine dependence, unspecified, uncomplicated is a medical classification as listed by WHO under the range - Mental, Behavioral and Neurodevelopmental disorders .
What is CPT code G0437?
2022 HCPCS Code G0437 : Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes.
What is the CPT code for tobacco screening?
for tobacco use screening, the preventive counseling E/M codes are used. Codes 99406 and 99407 are selected according to the time spent counseling the patient regarding tobacco cessation during a face to face visit.
Which code can be used for asymptomatic or physician's office for smoking and tobacco use cessation counseling visits for more than 10 minutes?
Note: G codes are for asymptomatic patient counseling in the physician office setting; C codes are for asymptomatic patient counseling in the hospital outpatient setting. ❖ 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Is I10 a billable code?
ICD-Code I10 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Essential (Primary) Hypertension. Its corresponding ICD-9 code is 401.
CPT code 99406, 99407 , C9801, C9802 – Tobacco Use Cessation ...
Procedure code description • 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 Tobacco Use Cessation Counseling. Medicare covers counseling for tobacco cessation for outpatients and for inpatients.
Smoking cessation coding, 99406 and 99407
Physicians often discuss smoking cessation with their patients who smoke. This article reviews the guidelines for billing these services. CPT® codes 99406, 99407
CMS Manual System
CMS / CMM / MCMG / DCOM Change Request Form: Last updated 23 August 2007 Page 1 Attachment –Business Requirements Pub. 100-04 Transmittal: 1433 Date: February 1, 2008 Change Request: 5878
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare ... - CMS
Short Descriptor Long Descriptor . OPPS SI OPPS APC Effective Date C9744 Abd us w/contrast Ultrasound, abdominal, with contrast S 5571 10/01/2016
Coding for Smoking Cessation Services - hfma
While this is a medically necessary and payable service, there are some documentation requirements to support billing. Question: What are the codes for smoking cessation services, and what tips should coders keep in mind when coding for this service?. Answer: Smoking cessation care is often administered and not billed.In other instances, it may be billed, but not fully supported in the ...
How many tobacco cessation attempts are covered by Medicare?
Medicare. Medicare Part B covers two levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate and intensive. Two cessation attempts are covered per 12-month period. Each attempt may include a maximum of four intermediate or intensive counseling sessions.
What is coding for tobacco screening?
The Patient Protection and Affordable Care Act began requiring insurance plans to cover preventive services such as tobacco use screening for all adults and adolescents, and tobacco cessation counseling for adults and adolescents who use tobacco .
What is the ACA preventive care plan?
In 2014, the Patient Protection and Affordable Care Act (ACA) began requiring isurance plans to cover many clinical preventive services. Two of the covered preventive services include: Tobacco use screening for all adults and adolescents.
Does Medicare cover smoking cessation?
The Centers for Medicare and Medicaid Services encourage state partners to support smoking cessation by ensuring coverage of all FDA-approved smoking cessation medication (prescription and over-the-counter [OTC]) without a copayment requirement or other financial barrier. Private/Commercial Insurance Carriers.
When did CMS accept a request for tobacco cessation counseling?
On June 23, 2004, CMS accepted a request from the President of Partnership for Prevention to expand coverage for tobacco cessation counseling. Their letter requested that CMS cover tobacco cessation counseling for Medicare beneficiaries with smoking related disease or symptoms of smoking related disease as detailed in the PHS 2000 Guideline.
How long is the comment period for tobacco cessation?
The first comment period was at the start of this national coverage analysis. CMS allowed the first 30 days for the public to comment on any issue related to the request by Partnership for Prevention for coverage of tobacco use cessation counseling. Responses for the initial comment period are summarized below.
What is smoking cessation?
Smoking cessation (abstinence) information is a substitute endpoint (surrogate) for the important clinical measures of improved health outcomes in the evaluation of the effectiveness of cessation counseling. The effectiveness of tobacco use counseling can be judged based on the ability to bring about abstinence, as abstinence has been shown to improve health outcomes. Abstinence is the chief outcome measure in many studies of the effectiveness of cessation counseling. While permanent abstinence after quitting is the most desirable outcome, tobacco abuse is a chronic problem with many patients eventually returning to tobacco use (relapse). The variability in the definition of relapse creates difficulty in examining prolonged abstinence in studies. For some researchers, relapse may occur as quickly as one day after a patient begins a quit attempt, while other definitions include at least seven consecutive days of smoking. Smoking status can be assessed through self- or interviewer-administered questionnaires. Self-reported cessation rates can be validated by measuring expired carbon monoxide, saliva cotinine, or serum thiocyanate.
What is the development of an assessment in support of Medicare coverage decisions?
The development of an assessment in support of Medicare coverage decisions is based on the same general question for almost all requests: "Is the evidence sufficient to conclude that the application of the technology under study will improve net health outcomes for Medicare patients?"
What does CMS recognize about intervention?
CMS recognizes that the assessment of an intervention can depend substantially on how it is delivered, to whom it is applied, the alternatives with which it is being compared and the delivery setting. In this decision, CMS sought to address the following questions:
How many comments were received in the 2004 decision memo?
In response to the proposed decision memorandum posted on December 23, 2004, we received 350 comments from both individuals and groups during the required statutory period ending January 21, 2005. Commenters included major national professional associations, national organizations, patient advocacy groups, industry representatives, health systems and medical centers, practicing professionals, and other individuals. Comments were generally in support of the coverage proposed in the draft decision memorandum, with some commenters wanting an expansion of services in various areas. These suggestions were taken into consideration in the final analysis. A summary of the comments is provided below.
Can hypnotists provide smoking cessation services?
A number of commenters expressed concern that in the proposed decision memorandum various health care professionals, such as pharmacists, retail druggists, respiratory therapists, Masters level professionals, hypnotists, and laser therapists were not recognized as being eligible to furnish smoking cessation services to Medicare beneficiaries. These commenters indicated that the various additional health care professionals and other suppliers of medical services are fully qualified to provide the proposed counseling services and that they should be recognized for that purpose in the final Decision Memorandum. The Medicare law limits coverage of medical services to those providers or suppliers of medical services that were recognized as Part B benefit categories as specified in the proposed Decision Memorandum and reiterated in Section III of this document.
How many cessation attempts does CMS cover?
CMS will cover two cessation attempts per year. An attempt may include up to four intermediate or intensive sessions, so up to eight sessions could be covered in a 12-month period. It must be noted that other payers may cover cessation attempts at different frequencies.
How long does a 99406 counseling visit take?
99406-Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes and up to 10 minutes. 99407-Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes.
Is smoking cessation a requirement?
There are no required guidelines on what type of smoking cessation should be administered, but the service should be documented and reported.
Is smoking cessation billed or supported?
In other instances, it may be billed, but not fully supported in the documentation. While this is a medically necessary and payable service, there are some documentation requirements to support billing, which are more substantial than simply including the phrase “smoking cessation for 3 minutes.”.
Is smoking cessation counseling necessary?
While different payers may have different criteria, the Centers for Medicare & Medicaid Services (CMS) “has determined that the evidence is adequate to conclude that smoking and tobacco use cessation counseling, based on the current U.S. Public Health Service [ PHS] Guideline, is reasonable and necessary for a patient with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information. Patients must be competent and alert at the time that services are provided” (“ Decision Memo for Smoking & Tobacco Use Cessation Counseling ,” CMS).
What is the CPT code for smoking cessation?
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.
How much does Medicare reimburse for smoking cessation?
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.
How many cessation attempts are there for Medicare?
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.
How long does a doctor spend counseling a patient on tobacco?
Follow-up arranged. Amount of time spent counseling patient. An entry in the patient’s health record simply stating that the doctor spent 11 minutes counseling the patient on tobacco use will not cut it and will not meet the standard for medical necessity or to be able to bill the codes.
What documentation is needed for cessation?
The documentation in the medical record must support the billing of the cessation code. The documentation needs to record what was discussed during counseling and should show a significant and separately identifiable service.
What are some resources that a doctor can provide to help a patient quit smoking?
They offer free support and tools to get the person to stop smoking.
How to contact the CDC about smoking?
The CDC mentions calling 1-800-QUIT-NOW (1-800-784-8669). This can help if the patient is not computer savvy, but wants help. They will also give free support and advice, developing a plan that’s right for the patient. Steps to helping our patients become smoke-free are reimbursed by many insurance companies.
How long does it take to get tobacco cessation counseling?
Medicare Part B (provider component) covers two levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate (great than 3 minutes but no more than 10 minutes) and intensive (greater than 10 minutes).
What is HCPCS coding?
Similar to the CPT code set, HCPCS is a standardized coding set used by the Centers for Medicare and Medicaid Services, as well as other payers. Like CPT, it includes three levels or categories of codes:
What is the F17 code?
The F17 codes are used if the patient is dependent on tobacco. The Z codes are used if there is NOT dependence on tobacco. The Z codes cannot be combined with an F17 code.
What is CPT medical?
It provides a uniform mechanism for describing services and procedures among providers, payers, and patients, as well as coders and analytical entities. For this document, CPT establishes what services or procedures have been provided and the basis for payment by payers.
What is the ICD-10 code used for?
ICD-10 codes are used by physicians and other health care providers to classify and code all diagnoses, symptoms, and procedures in U.S. health care settings on claims for services provided. These codes are used by payers to determine coverage, not the amount that will be paid. Separately, payers have schedules which match the codes to the specific provider’s negotiated rate.
Is tobacco use covered by Medicare?
Tobacco use status is now embedded in most of the major electronic health records and evidence-based tobacco cessation counseling and pharmacotherapy covered by Medicare, Medicaid and most private health plans. Despite improved documentation and coverage, few providers bill for cessation services.
Does the Affordable Care Act cover tobacco?
The Affordable Care Act (ACA) expanded tobacco cessation coverage for the Medicaid population, but gives states the ability to distinguish between the standard Medicaid and Medicaid expansion populations in terms of cessation coverage.