Make sure your smoking cessation services are being coded right

by  Codapedia
July 29th, 2016

Coding, billing and getting paid for providing smoking cessation services when covered by your payers is almost a no-brainer for any physician practice because, in most cases, cessation services are already being provided to patients who smoke cigarettes. 

    Yet practices consistently don’t take advantage of this opportunity and, when they do, don’t follow the instructions for use of the codes, making the service not payable and raising the practice’s audit risk.

    The two smoking cessation codes are 99406 (intermediate smoking cessation counseling, 3-10 minutes) and 99407 (intensive, greater than 10 minutes). Medicare, for example, pays around $15-$16 for 99406 depending on your geographic area, and $29-$30 for 99407. These codes can be billed in addition to any E/M services provided to the patient.

    Different payers cover smoking cessation in different ways. Medicare will allow you to make two cessation attempts per year, with each attempt consisting of up to four intermediate or intensive sessions. In other words, you can bill these codes up to eight times a year per patient. 

    Medicare will cover smoking cessation for all smoking beneficiaries, regardless of whether or not the patient has a smoking-related disease or illness. Patients who don’t have any smoking related conditions need not pay a copay or deductible for smoking cessation services. Patients with a smoking-related condition do pay the 20 percent copay and deductible. 

    When a patient who smokes is with the physician, the physician should always engage the patient about quitting, and guide the conversation to specific strategies around how to quit in order to bill for this service. Some patients will, of course, decline all attempts at cessation efforts. The physician should nonetheless continue to try to engage the patient around quitting at each visit. 

    Here are the two common mistakes made by practices billing smoking cessation counseling services:

   Remember that you are able to bill an E/M encounter and tobacco cessation counseling on the same date of service, but that the time spend on tobacco counseling is not considered part of the E/M service and should be considered separately. 
   Minimal tobacco counseling, such as just advising the patient to quit, would be considered part of the E/M service and not separately billable.


Make sure your smoking cessation services are being coded right. (2016, July 29). Find-A-Code Articles. Retrieved from

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