Fiscal Intermediary (FI) Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11)

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.

References:

Fiscal Intermediary (FI) Billing Requirements for Counseling to Prevent Tobacco Use (Rev. 2058, 01-03-11). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/fiscal-intermediary-fi-billing-requirements-for-counseling-to-prevent-tobacco-use-rev-2058-01-03-11-27047.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.