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Preventive Services: Counseling to Prevent Tobacco Use

By:  Find-A-Code
Published:  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: 

HCPCS/CPT Codes

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

ICD-10 Codes

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

Frequency

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

Other Notes

  • 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.


References:

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