• 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
Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407). If you bill using the former HCPCS codes (G0375 and G0376) for services provided after December 31, 2007, your claims will not be paid.
CR 5878, from which this article is taken, announces that the 2008 Medicare Physician Fee Database (MPFSDB) includes two new CPT codes for smoking and tobacco use cessation counseling services; replacing the temporary HCPCS G codes (G0375 and G0376) currently in use for billing these services. These new codes (effective on and after January 1, 2008) are:
• 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and
• 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes.
CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December31, 2007.
They are being replaced by two new CPT codes (99406 – Smoking and tobaccouse cessation counseling visit; intermediate, greater than 3 inutes up to 10.
The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for dates of service on or after January 1, 2011. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals.
Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011. The new G codes for use on claims with dates of service on or after January 1, 2011 are:
• G0436: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short Descriptor: Tobacco-use counsel 3-10 min;
• G0437: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min.
Tobacco Use Cessation Counseling
Medicare covers counseling for tobacco cessation for outpatients and for inpatients. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patient’s hospital stay. Medicare covers 2 cessation attempts per year.
The counseling during an E/M service must be either intermediate or intensive. Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. Intensive counseling is 4 sessions of more than 10 minutes each. Counseling involving only 1 session lasting less than 3 minutes is considered part of an E/M service and is not reimbursed separately. Each attempt may include a maximum of four intermediate or intensive counseling sessions. The total annual benefit is for 8 sessions in a 12 month period.
Services may be provided by a physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker. CMS does not currently have specific training requirements, but may in the future. The counseling must be provided face-to-face with the patient.
These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). The diagnosis code should reflect the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.
Optum will align reimbursement with Medicare including up to 2 attempts of up to 4 sessions each for a total of up to 8 face-toface visits during a 12-month period for individuals who use tobacco – regardless of whether there are signs or symptoms of tobacco-related disease. These visits must be provided by a qualified health care provider.
The diagnosis codes that should be reported for individuals who do not have signs or symptoms of tobacco-related disease individuals are:
• ICD-9 code 305.1 (non-dependent tobacco use disorder)
• ICD-9 code V15.82 (history of tobacco use)
Minimal counseling (<3 e="" in="" included="" is="" minutes="" p="" service.="" the="">
Medicare also allows for the reporting an E/M visit (99201-99215) in addition to the tobacco-counseling, if modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the E/M
CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period.
NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed.
Claims for these counseling services must be submitted with the appropriate diagnosis code. Diagnosis codes should reflect the condition the patient has that is adversely affected by tobacco us, or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.
Deductible and coinsurance will apply in a standard medical benefit. If the member has the preventive medical benefit, the deductable and coinsurance will not apply, and any diagnosis code will also apply.
Facilities should report the service on a UB-1450 form utilizing bill type 12X, 13X, 22X, 23X, 34X, 71X, 73X, 83X, or 85X with reimbursement mapping to the correct method of payment (usually the outpatient facility fee schedule)
-Elite, HMO, PPO, Advantage
Medicare will allow two smoking cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive sessions. A total of eight sessions are covered in a 12-month period. However, these limits do not apply to Paramount members as they are allowed an unlimited number of visits.
Smoking cessation (99406 and 99407) services were developed as E/M services and may be reported with the E/M services 99201-99205 and 99211-99215. They will be denied “IN” (service incidental to primary procedure, no patient liability) with all other E/M services. If the physician performs a comprehensive preventative medicine evaluation for new patients (99381-99387) or established patients (99391-99397), the smoking cessation counseling is included within the scope of the service.
Use of modifier 25 is required on the E&M code to identify smoking cessation counseling as a separately reimbursable service.