Smoking and tobacco cessation counseling, covered indications and # of visits

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 23rd, 2016

Nationally Covered Indications:
Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries

1.  Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;

2.  Who are competent and alert at the time that counseling is provided; and

3.  Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

Intermediate and intensive smoking cessation counseling services will be covered under Medicare Part B when the above conditions of coverage are met, subject to frequency and other limitations.  That is, similar to existing tobacco cessation counseling for symptomatic individuals, CMS will allow 2 individual tobacco cessation counseling attempts per 12-month period.  Each attempt may include a maximum of 4 intermediate OR intensive sessions, with a total benefit covering up to 8 sessions per 12-month period per Medicare beneficiary who uses tobacco. 

The practitioner and patient have the flexibility to choose between intermediate (more than 3 minutes but less than 10 minutes), or intensive (more than 10 minutes) cessation counseling sessions for each attempt.

• HCPCS Code G0436 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
• HCPCS Code G0437 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
• CPT Code 99406 – Smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes
• CPT Code 99407 – Smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes

Do not code in addition to E/M visits.

References:

• CMS.gov