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 minutes ).
Full Answer
When to use G codes for Medicare?
· 1, CMS will no longer consider valid for Medicare purposes CPT codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than
What is the diagnosis code for smoking cessation?
· Two different CPT time-based codes may be used to capture this service: 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; These codes reflect behavior-change intervention services and should be …
Can Medicare help me to quit smoking?
HCPCS/CPT Code Type of Counseling Description 99406 Intermediate Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
What medications stop smoking?
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 …
How many times can you use 99406?
Rather, either of the codes may be used up to four times per attempt; so 99406 and 99407 or a combination of these codes may be used up to 8 times in a 12 month period.
Does Medicare cover tobacco cessation counseling?
According to the Medicare National Coverage Determination Manual, tobacco cessation counseling is covered both for symptomatic and asymptomatic smokers. CMS will allow healthcare providers two attempts per year to encourage Medicare patients to cease tobacco use but does not define an attempt. Rather, either of the codes may be used up ...
What is the CMS review of smoking cessation?
CMS commissioned an evidence-based systematic review of smoking cessation as part of its Healthy Aging project in 1998. The final report was prepared by the Rand Corporation for CMS, entitled Interventions to Promote Smoking Cessation in the Medicare Population. 21 This document used the methods of the Southern California Evidence Based Practice Center, an Agency for Healthcare Research and Quality designated center for the review of evidence on the benefits and harms of health care interventions. While some of the questions posed were similar, or identical, to questions assessed by the PHS 2000 Guideline panel, the focus of the Rand report was on Medicare programs and policies. The ten questions specified by CMS for analysis and the resulting answers are as follows:
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 VA 2.0A?
The VA/DoD guideline update 2.0a is a modification of the 1999 VHA/DoD Clinical Practice Guideline for the Management of Tobacco Use Cessation in the Primary Care Setting. The guideline recommendations were created by consensus from individuals at the VA, DoD, academia and guideline facilitators from the private sector. Published, peer-reviewed, randomized controlled trials were considered to be the strongest level of evidence in support of recommendations.
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:
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 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 CPT code for a patient who smokes?
If the patient has symptoms related to their tobacco use, practitioners should continue to submit payment using the CPT® codes 99406 (intermediate) and 99407 (intensive) for their counseling efforts.
When did CMS start paying for smoking cessation counseling?
Beginning on August 25th, 2010, CMS began paying for smoking cessation counseling even in patients without smoking related illness and introduced several new codes to account for that difference. See below for details.
What documentation is needed for a Medicare beneficiary who is smoking?
Medical record documentation must show, for each Medicare beneficiary for whom a smoking and tobacco-use cessation counseling or counseling to prevent tobacco use claim is made, standard information along with sufficient beneficiary history to adequately demonstrate that Medicare coverage conditions were met.
What is cessation counseling?
A cessation counseling attempt occurs when a qualified physician or other Medicare-recognized practitioner determines that a beneficiary meets the eligibility requirements and initiates treatment with a cessation counseling attempt.
What is the ICD-9 code for tobacco use?
Since this new policy does not require an ICD diagnosis related illness, what code should be used for tobacco users without a tobacco related disease? CMS gives guidance on that as well, instructing providers to use ICD-9 codes V15.82 (history of tobacco use) or 305.1 (non-dependent tobacco use disorder) in these circumstances.
Does Medicare pay for smoking cessation?
Since late 2009, Medicare had paid for quit smoking counsel ing only if the patient had symptoms of tobacco related disease. Physicians have collected payment using CPT® codes 99406, smoking and tobacco-use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes and CPT® 99407, smoking and tobacco-use cessation counseling ...
Can a physician submit a cessation code?
I could not find any information that defined a start and end time to a cessation counseling attempt. My understanding is that any physician or other qualified practitioner can submit these codes. As a hospitalist, I submit these codes all the time. What better time to quit smoking than to be hospitalized in a campus wide no smoking environment filled with doctors and nurses? As an additional benefit, Medicare's prescription drug benefit plans should cover tobacco cessation pharmaceuticals.
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.
What is Medicaid managed care?
Medicaid managed care organizations (MCOs) are required to provide at least a comparable level of benefits to the fee-for-service option (77 percent of state Medicaid recipients are currently served by Medicaid MCOs).
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.