by Jared Staheli
July 6th, 2015
The FIs shall pay for counseling to prevent tobacco use services with codes G0436 and G0437 for dates of service on or after January 1, 2011. FIs shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010, through December 31, 2010. For facilities paid under OPPS, FIs shall pay for counseling services billed with codes C9801 and C9802 for dates of service performed on or after August 25, 2010, through December 31, 2010.
Claims for counseling to prevent tobacco use services should be submitted on Form CMS-1450 or its electronic equivalent.
The applicable bill types are 12X, 13X, 22X, 23X, 34X, 71X, 77X, and 85X.
Payment for outpatient services is as follows:
|Type of Facility||Method of Payment|
|Rural Health Centers (RHCs) TOB 71X/Federally Qualified Health Centers (FQHCs)TOB 77X||All-inclusive rate (AIR) for the encounter|
|Hospitals TOBs 12X and 13X||OPPS for hospitals subject to OPPS MPFS for hospitals not subject to OPPS|
|Indian Health Services (IHS) Hospitals TOB 13X||AIR for the encounter|
|Skilled Nursing Facilities (SNFs) TOBs 22X and 23X||Medicare Physician Fee Schedule (MPFS)|
|Home Health Agencies (HHAs) TOB 34X||MPFS|
|Critical Access Hospitals (CAHs) TOB 85X||Method I: Technical services are paid at 101% of reasonable cost. Method II: technical services are paid at 101% of reasonable cost, and Professional services are paid at 115% of the MPFS Data Base|
|IHS CAHs TOB 85X||Based on specific rate|
|Maryland Hospitals||Payment is based according to the Health Services Cost Review Commission (HSCRC). That is 94% of submitted charges subject to any unmet deductible, coinsurance, and non-covered charges policies.|
Deductible and coinsurance apply for services performed on August 25, 2010, through December 31, 2010. For claims with dates of service on and after January 1, 2011, coinsurance and deductible do not apply for G0436 and G0437.