Under the “incident to” benefit, respiratory therapists are most likely to furnish smoking cessation counseling in a freestanding physician’s office and in the hospital outpatient setting as long as the regulatory requirements are met. Respiratory therapists may be able to provide various types of smoking cessation services in a hospital or skilled nursing facility (SNF), but the services would be covered as a Part A benefit, not under the new Part B smoking cessation benefit. This is because the intermediate and intensive counseling sessions that are reimbursable under the NCD that became effective March 22, 2005, are available as a Part B benefit to physicians and other Medicare-recognized practitioners who can bill Medicare directly and be paid for the service.
Full Answer
How many smoking cessation counseling sessions does Medicare cover?
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 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 Part B cover smoking counseling?
Medicare Part B (Medical Insurance) covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month period smoking if you use tobacco. You pay nothing for the counseling sessions if your doctor or other qualified health care provider accepts Assignment.
How many times can I visit the doctor to quit smoking?
covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month period smoking if you use tobacco.
What is a smoking cessation practitioner?
The role of the Stop Smoking Practitioner is to support the delivery of evidenced based, equitable stop smoking services to help to reduce the inequalities throughout the contracted localities. This will include the delivery of services within areas of most deprivation.
Is 99406 covered by Medicare?
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.
Which code can be used for asymptomatic or physicians 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.
What ICD 10 code to use for smoking cessation?
F17. 211 Nicotine dependence, cigarettes, in remission.
WHO can bill for 99406?
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.
Does Medicare B cover smoking cessation?
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. covers up to 8 smoking and tobacco-use cessation counseling sessions in a 12-month period.
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.
What is the CPT code for smoking cessation?
99406 and 99407In the body of the note, the clinician must document the time of the counseling. The CPT codes for smoking cessation (99406 and 99407) are used for all payers for patients who are symptomatic as a result of smoking.
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.
Which of the following medications may be prescribed for smoking cessation?
Varenicline (Chantix) Varenicline (also called Chantix) is a prescription medicine developed to help people stop smoking.
What is code 1036F?
Patient Screened for Tobacco Use and Identified as a Tobacco Non-User. Performance Met: CPT II 1036F: Current tobacco non-user. OR. Tobacco Screening not Performed OR Tobacco Cessation Intervention not Provided for Medical.
What is DX f17200?
F17. 200 - Nicotine dependence, unspecified, uncomplicated | ICD-10-CM.
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.
When was the final decision for smoking cessation counseling issued?
On March 22, 2005, CMS issued a final “Decision Memo for Smoking & Tobacco Use Cessation Counseling” (CAG-00241N). The memo determined that smoking cessation counseling services, based on current Public Health Service guidelines, were reasonable and necessary for the treatment of certain individuals with a disease or adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use based on FDA-approved information.
Can a respiratory therapist provide smoking cessation counseling?
Under the “incident to” benefit, respiratory therapists are most likely to furnish smoking cessation counseling in a freestanding physician’s office and in the hospital outpatient setting as long as the regulatory requirements are met. Respiratory therapists may be able to provide various types of smoking cessation services in a hospital or skilled nursing facility (S NF), but the services would be covered as a Part A benefit, not under the new Part B smoking cessation benefit. This is because the intermediate and intensive counseling sessions that are reimbursable under the NCD that became effective March 22, 2005, are available as a Part B benefit to physicians and other Medicare-recognized practitioners who can bill Medicare directly and be paid for the service.
Does Medicare cover smoking cessation counseling?
According to the NCD, smoking cessation counseling is available to “hospital beneficiaries who are smokers” and meet certain requirements, as long as the services are furnished by qualified physicians and other Medicare-recognized practitioners. It is a fundamental rule of the Medicare program that no Medicare payment may be made under Part B for any services to the extent the beneficiary is entitled to have payment made with respect to such services under Part A. For services to be covered under Part A or Part B, a hospital must also furnish non-physician services to its inpatients directly or under arrangements. According to CMS manual instructions, except for nurse anesthetists employed by anesthesiologists, services “incident to” physicians’ services are non-physician services for purposes of this provision.
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.
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
I. Decision
- 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. Surgeon...
II. Background
- Tobacco use continues to be the leading cause of preventable death in the United States. In 1964, the Surgeon General of the U.S. Public Health Service issued the report of his Advisory Committee on Smoking and Health, officially recognizing that cigarette smoking is a cause of cancer and other serious diseases. Though smoking rates have significantly declined, 9.3 percent (95% CI = …
III. History of Medicare Coverage
- The Centers for Medicare & Medicaid Services (CMS) has not previously issued a National Coverage Determination for smoking and tobacco use cessation counseling. Local Medicare contractors currently have discretion to cover these services when they determine them to be medically necessary for the individual patient. The benefit categories for smoking cessation cou…
IV. Timeline of Recent Activities
- 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.
v. General Methodological Principles
- When making national coverage decisions, CMS evaluates relevant clinical evidence to determine whether or not the evidence is of sufficient quality to support a finding that an item or service is reasonable and necessary. The overall objective for the critical appraisal of the evidence is to determine to what degree we are confident that: 1) specific clinical questions relevant to the cov…
VI. Evidence
- A. Introduction 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 improv…
VII. CMS Analysis
- National coverage determinations (NCDs) are determinations by the Secretary with respect to whether or not a particular item or service is covered nationally under title XVIII of the Social Security Act § 1869(f)(1)(B). In order to be covered by Medicare, an item or service must fall within one or more benefit categories contained within Part A or Part B, and must not be otherwi…
VIII. Decision
- 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 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 tak…