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
Full Answer
What does Medicare cover for smoking cessation?
Smoking cessation services fall under Medicare Part B, which covers a variety of preventive services. You’re covered for up to two attempts at quitting each year. Each attempt includes four face-to-face counseling sessions, for a total of eight covered sessions per year.
Does hypnosis really work for smoking cessation?
The short answer is yes. Some compelling research has found that hypnosis can be an effective tool for helping you quit – with quit rates that easily beat more traditional methods. Yet, the consensus seems to be that, like with any smoking cessation program, you have to want the results. Hypnotherapy is not the best option if:
How to mentally prepare yourself to quit smoking?
Some other strategies that can help shift your mindset toward quitting smoking include:
- Watching your language: If you find yourself engaging in negative self-talk, look for ways to shift into a more positive approach. ...
- Learning from mistakes: Instead of feeling defeated by your slip-ups, consider what you can learn from them. ...
- Finding social support: Seek out supportive people who can offer encouragement and act as cheerleaders. ...
How do you help someone quit smoking?
Tips for Helping a Smoker Quit
- Ask your friend or family member what they think they need to most
- Ask them what the best thing you could do for them
- Tell your friend that you know he or she can quit smoking for good, even if he or she has tried to quit before.
- For the first few days after the smoker quits, be ready to help. ...
- Offer to call or visit to check on them. ...
How do you bill smoking cessation counseling?
Smoking Cessation Counseling Codes 99406 and 99407 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.
What is the CPT code for smoking cessation?
In 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 CPT 99406 require a modifier?
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.
How often can you bill smoking cessation counseling?
Two cessation attempts are covered per 12-month period. Each attempt may include a maximum of four intermediate or intensive counseling sessions, for a total of eight counseling sessions in the year.
WHO can bill for 99408?
The SBI CPT codes (99408, 99409) can be added to other Evaluation and Management (E & M) codes for office or other outpatient services (99210-99215), for physician or other health care provider services in the emergency department (99281-99285), or physician or other health care provider inpatient consultations (99251- ...
What diagnosis code is 99406?
Supporting ICD 10 codes for CPT code 99406 & 99407 A code for code section F17 can be reported for nicotine dependence. Toxic effects of tobacco and nicotine can also be reported with CPT code 99406 & 99407 from T65.
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.
Does time have to be documented for 99406?
If a provider is reporting the use of the codes 99406 or 99407 they must be documented and clearly separate from the services provided under the prevention E/M code. It is critical to document time spent on counseling in the medical record and include topic and specifics of the counseling.
Will Medicare pay for smoking cessation?
Counseling to prevent tobacco use & tobacco-caused disease 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.
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.
Does Medicare pay for G0442?
Medicare pays for an annual screening for alcohol misuse for all Medicare beneficiaries using HCPCS code G0442. For those who screen positive, Medicare also pays for a brief face-to-face behavioral counseling session, HCPCS code G0443. Both of these are 15 minute codes.
Does CPT 99401 need a modifier?
CPT code 99401 is restricted to one unit per day, per unvaccinated member, per provider. When billing, providers must include modifier 25 – Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, or the claim detail will deny.
What is CPT code 1126f?
The provider measures the severity of pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period. Report this code if the patient does not experience pain. start codify free trial. View any code changes for 2022 as well as historical information on code creation and revision.
What is CPT code 4004F?
NUMERATOR NOTE: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation intervention, or if tobacco status is unknown, submit 4004F with 8P. This measure defines tobacco cessation counseling as lasting 3 minutes or less.
What is CPT code 1036f?
The provider screens a patient of 18 years of age or older for the use of tobacco. Use this code if the provider identifies the patient to be a nonuser of tobacco.
What is CPT code 1000F?
The Current Procedural Terminology (CPT®) code 1000F as maintained by American Medical Association, is a medical procedural code under the range - Patient History.
What is the code for smoking cessation?
99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. 99407 – intensive, greater than10 minutes. HCPCS Level II Codes. G0436 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes.
Can you bill for counseling?
Yes, you really can bill for these services, but not every payer will reimburse you. Let’s look at the codes and descriptor requirements. Note that if you counsel the patient for fewer than three minutes, you would not report these codes. Be sure that the time spent counseling is specified in the medical record.
Can you bundle E/M services to another E/M?
Payers who do not reimburse for these services may, nonetheless, apply the charges toward any unmet patient deductable. Other payers may bundle the services to any other E/M service on the same day. Check with your insurance plans for details, so that you are able to inform patients whether the service will be covered.
What is the code for smoking cessation?
The two codes are: 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes. 99407 intensive, greater than 10 minutes. Note: These codes are typically billed by internal medicine and family practice who assume full care for smoking cessation as additional documentation is required.
What is the 99407?
For 99407, the physician may include motivational interviewing techniques to address the positives and negatives for tobacco cessation. Additional therapies may be prescribed including nicotine replacement, pharmacologic adjuncts, support groups or a combination.
Where Can Smokers Get Additional Help?
A couple of resources your doctor can provide to their patients are: The American Lung Association hosts the Freedom From Smoking group that helps coach the smoker to quit. They offer free support and tools to get the person to stop smoking.
How many cessation attempts are there for Medicare?
Reimbursement may be possible if you bill the patient’s insurance company correctly. Medicare covers 2 ces sation 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.
When is the Great American Smoke Out?
The American Cancer Society’s Great American Smoke Out is a nationwide day, the third Thursday in November, dedicated to helping smokers stop smoking. So far, it has worked! There are now more former smokers in the Nation than current smokers.
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.
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?"
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 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 people die from smoking in the US?
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 = ± 0.8) of the population age 65 and older smokes cigarettes. 1 Approximately 440,000 people die annually from smoking related disease, with 68% (300,000) age 65 or older. 2 Many more people of all ages suffer from serious illness caused from smoking, leading to disability and decreased quality of life. 3 Reduction in smoking prevalence is a national objective in Healthy People 2010 (U.S. Department of Health and Human Services [USDHHS] 2000).
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.
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
Does Medicare cover tobacco cessation?
The Centers for Medicare & Medicaid Services (CMS) set a standard for coverage (which commercial payers may not follow). Per MLN Matters ® article MM7133, CMS will cover tobacco cessation counseling for beneficiaries:
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 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.
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.
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).
