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
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
What is the CPT code for smoking cessation counseling?
99407 intensive, greater than 10 minutes G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes G0437 intensive, greater than 10 minutes These counseling services must be submitted with appropriate diagnosis coding to support medical necessity.
Does Medicare cover tobacco cessation counseling?
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.
When to use unlisted code 99199 to bill for tobacco counseling?
Therefore, contractors shall advise non-outpatient perspective payment system (OPPS) providers to use unlisted code 99199 to bill for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010.
What is the CPT code for tobacco use?
CPT codes for Smoking CessationCodeDescription2022 wRVU99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes0.2499407greater than 10 minutes0.50Feb 1, 2022
Does Medicare pay CPT 99406?
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.
What is the ICD 10 code for smoking counseling?
Z71. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
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 ICD 10 code for tobacco use?
Z72. 0 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 Z72.
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.
WHO can bill CPT 99401?
Providers must bill CPT 99401 with a CR modifier and there is no requirement for a specific diagnosis code. Providers are encouraged to counsel Medicaid beneficiaries of any age.
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.
What is CPT code 4004F?
CPT® Code 4004F - Therapeutic, Preventive or Other Interventions - Codify by AAPC.
Does Medicare pay for g0447?
Medicare pays for ongoing face-to-face behavioral counseling for patients with a BMI of ≥ 30, who are alert and able to participate in counseling.
What is CPT code G0436?
CPT Code. G0436. Smoking and tobacco use cessation. counseling visit; intermediate, greater. than 3 minutes up to 10 minutes.
What is CPT code G0442?
G0442 & G0443 – Screening for alcohol misuse and brief behavioral counseling.
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 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.
Is a medical coding professional a substitute for a medical coding professional?
It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor.
Is smoking cessation covered by Medicare?
In 2014, smoking cessation became a covered benefit under the Affordable Care Act (Obamacare). This means that Medicare and commercial insurance carriers must provide smoking cessation counseling and interventions. These services include: Tobacco use screening for all adults and adolescents.
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 ...
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.
How long is an intensive counseling session?
Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. Intensive counseling is 4 sessions of more than 10 minutes each. Counseling involving only 1 session lasting less than 3 minutes is considered part of an E/M service and is not reimbursed separately. Each attempt may include a maximum of four intermediate or intensive counseling ...
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.
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.
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.
Is there a smoking cessation policy for LG XL?
LG. XL. 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 care billed?
Answer: Smoking cessation care is often administered and not billed. 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 ...
How many counseling sessions are covered by Medicare?
The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare covered cessation counseling session was performed.
What is CPT code 99381?
If your clinic is just beginning to provide these services to your patient population, it’s best to verify coverage criteria prior to claim submission. For instance, Preventive Medicine Services guidelines in the CPT® codebook state, “Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination.” Many payers group tobacco use cessation counseling under this umbrella and will not reimburse it separately. Knowledge of potential reimbursement errors keeps the denial rate low and provider-patient relationships strong.#N#Resources#N#www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf#N#www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7133.pdf#N#www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/#N#www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-success-rates
How to improve your chances of reimbursement?
Proper documentation and verifying coverage criteria prior to claim submission can improve your chances for reimbursement. Many healthcare providers perform tobacco use counseling daily, but they may not be documenting or reporting it appropriately. Reliable guidance is needed to ensure all performed services are claimed ...
Does Medicare cover cessation counseling?
Private payers may follow CMS’ direction when it comes to billing requirements for these services; however, it’s important to know your patient’s insurance benefits.#N#Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive counseling sessions.#N#The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare covered cessation counseling session was performed.#N#Example: The beneficiary received the first of eight covered sessions in January 2011. The count starts beginning February 2011. The beneficiary is eligible to receive a second series of eight sessions in January 2012. Medicare’s prescription drug benefit also covers smoking and tobacco-use cessation agents prescribed by a physician.#N#CMS specifies symptomatic patient criteria as beneficiaries “who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco related disease.”#N#CPT® descriptions:#N#99406 Smoking and tobacco cessation counseling visit for the symptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes#N#99407 intensive, greater than 10 minutes#N#G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes#N#G0437 intensive, greater than 10 minutes#N#These counseling services must be submitted with appropriate diagnosis coding to support medical necessity. The claim and documented encounter should include tobacco use status and confirmed tobacco-related diseases, as appropriate.#N#Example: A 67-year-old male Medicare patient presents with exacerbated COPD on oxygen. This patient continues to smoke one pack of cigarettes per day after several failed attempts at quitting. Approximately 15 minutes were spent counseling the patient in cessation techniques. He understands continuing to smoke could lead to stroke and death. The benefits of stopping were also presented to him. The patient has verbalized his desire to “give it another try.” He has set his own goal of 30 days to be completely smoke-free. We will follow up in two weeks to check progress.#N#CPT® coding:#N#99407#N#ICD-10-CM coding:#N#F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders#N#J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
Decision Summary
The Centers for Medicare and 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.
Decision Memo
The Centers for Medicare and 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.