September 1st, 2017
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Counseling to Prevent Tobacco Use:
|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|
F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A, and Z87.891
NOTE: Additional ICD-10 codes may apply.
Who Is Covered
Outpatient and hospitalized Medicare beneficiaries for whom all of the following are true:
- Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
- Competent and alert at the time of counseling
- Counseling furnished by a qualified physician or other Medicare-recognized practitioner
Two cessation attempts per year. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions per year.
Medicare Beneficiary Pays
- Copayment/coinsurance waived
- Deductible waived
- Effective September 30, 2016, HCPCS codes G0436 and G0437 are deleted. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits.
Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.
Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.