If a patient is seen for tobacco cessation counseling with a medical provider, and had no other qualifying services, the CPT 99406 or 99407 could be billed under the applicable PPS G code. This way, the FQHC would be reimbursed at the full PPS amount.
How do I Bill for smoking cessation?
Check with your local Medicare carrier or private insurance company for their rules and requirements before billing for smoking cessation. The documentation in the medical record must support the billing of the cessation code.
What is the CPT code for tobacco use cessation counseling?
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 A modifier 25 may be appropriate to append to the primary E/M visit code.
Is the decision memo for smoking&tobacco use cessation counseling reportable?
Patients must be competent and alert at the time that services are provided” (“ Decision Memo for Smoking & Tobacco Use Cessation Counseling ,” CMS). This service is reportable at the same time as an evaluation and management (E&M) service; however, the E&M service must be distinct and separate.
How much does smoking cessation counseling cost?
If you are already counseling for smoking cessation in your practice, you are doing the work, so get paid for it. Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $28.96. The 10 minute or longer consult may not apply to everyone.
What ICD 10 code for smoking cessation?
F17. 211 Nicotine dependence, cigarettes, in remission.
What is the CPT code for smoking cessation?
Smoking cessation coding, 99406 and 99407.
Do you need modifier 25 with 99406?
If billed alone, 99406 and 99407 are reimbursed. When billed with another evaluation and management code, the codes will bundle to a single fee. To allow payment in this circumstance, providers should append a “25” modifier for 99406 or 99407 codes.
Can 99406 and 99407 be billed together?
Description of CPT code 99406 & 99407 CPT code 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling.
Who can bill CPT 99401?
ProvidersProviders may bill CPT 99401 with ICD-10 code Z71. 89 for no member cost-share. Providers are encouraged to counsel all members who have not yet received their COVID-19 vaccination. This service can be provided by MD/DO, NP, PA, and/or CNM.
Who can bill CPT code 96127?
Who can bill CPT code 96127? Screening and assessment has to be completed under an MD supervision, and a MD needs to file the report. It means that, for example, primary care physicians can also bill it – not only psychiatrists.
Can 90471 and 99406 be billed together?
If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service.
Is CPT 99406 An EM code?
CPT code 99406 , 99407 (intermediate, intensive, E/M counseling service)
Does BCBS cover CPT 99406?
Policy: In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code.
What is the CPT code 99406?
HCPCS/CPT Code Type of Counseling Description 99406. Intermediate. Smoking and tobacco use. cessation counseling visit is. greater than three minutes, but.
What is CPT code 1036F?
CPT® Code 1036F - Patient History - Codify by AAPC.
How do you code nicotine dependence?
KMA Resource Guide.ICD-10 Coding for Tobacco Use/Abuse/Dependence.Category F17.21 is used to identify nicotine.dependence with cigarettes.Category F17.22 is used to identify nicotine.dependence with chewing tobacco.Category F17.29 is used to identify nicotine.dependence with other tobacco products.
How long does it take to get tobacco cessation counseling?
Medicare Part B (provider component) covers two levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate (great than 3 minutes but no more than 10 minutes) and intensive (greater than 10 minutes).
What is eValue in healthcare?
It is an in-depth assessment of health plan performance on critical processes that ensure patient safety, identify and close gaps in care, control costs, reduce and eliminate waste, and improve health and health care2. In 2015, the Centers for Disease Control Oce of Smoking and Health (CDC) worked with the National Alliance to update the tobacco questions. Plans responded in 2016 and analysis was completed in 2017. High level findings relevant to billing include:
What is HCPCS coding?
Similar to the CPT code set, HCPCS is a standardized coding set used by the Centers for Medicare and Medicaid Services, as well as other payers. Like CPT, it includes three levels or categories of codes:
What is CPT medical?
It provides a uniform mechanism for describing services and procedures among providers, payers, and patients, as well as coders and analytical entities. For this document, CPT establishes what services or procedures have been provided and the basis for payment by payers.
Is tobacco use covered by Medicare?
Tobacco use status is now embedded in most of the major electronic health records and evidence-based tobacco cessation counseling and pharmacotherapy covered by Medicare, Medicaid and most private health plans. Despite improved documentation and coverage, few providers bill for cessation services.
Does the Affordable Care Act cover tobacco?
The Affordable Care Act (ACA) expanded tobacco cessation coverage for the Medicaid population, but gives states the ability to distinguish between the standard Medicaid and Medicaid expansion populations in terms of cessation coverage.
Decision Summary
The Centers for Medicare and Medicaid Services (CMS) has determined that the evidence is adequate to conclude that smoking and tobacco use cessation counseling, based on the current U.S. Public Health Service (PHS) Guideline, is reasonable and necessary for a patient with a disease or an adverse health effect that has been found by the U.S.
Decision Memo
The Centers for Medicare and Medicaid Services (CMS) has determined that the evidence is adequate to conclude that smoking and tobacco use cessation counseling, based on the current U.S. Public Health Service (PHS) Guideline, is reasonable and necessary for a patient with a disease or an adverse health effect that has been found by the U.S.
How many cessation attempts does CMS cover?
CMS will cover two cessation attempts per year. An attempt may include up to four intermediate or intensive sessions, so up to eight sessions could be covered in a 12-month period. It must be noted that other payers may cover cessation attempts at different frequencies.
How long does a 99406 counseling visit take?
99406-Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes and up to 10 minutes. 99407-Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes.
Is there a smoking cessation policy for LG XL?
LG. XL. There are no required guidelines on what type of smoking cessation should be administered, but the service should be documented and reported.
Is smoking cessation care billed?
Answer: Smoking cessation care is often administered and not billed. In other instances, it may be billed, but not fully supported in the documentation. While this is a medically necessary and payable service, there are some documentation requirements to support billing, which are more substantial than simply including the phrase “smoking cessation ...
How to improve your chances of reimbursement?
Proper documentation and verifying coverage criteria prior to claim submission can improve your chances for reimbursement. Many healthcare providers perform tobacco use counseling daily, but they may not be documenting or reporting it appropriately. Reliable guidance is needed to ensure all performed services are claimed ...
Does Medicare cover cessation counseling?
Private payers may follow CMS’ direction when it comes to billing requirements for these services; however, it’s important to know your patient’s insurance benefits.#N#Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive counseling sessions.#N#The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare covered cessation counseling session was performed.#N#Example: The beneficiary received the first of eight covered sessions in January 2011. The count starts beginning February 2011. The beneficiary is eligible to receive a second series of eight sessions in January 2012. Medicare’s prescription drug benefit also covers smoking and tobacco-use cessation agents prescribed by a physician.#N#CMS specifies symptomatic patient criteria as beneficiaries “who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco related disease.”#N#CPT® descriptions:#N#99406 Smoking and tobacco cessation counseling visit for the symptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes#N#99407 intensive, greater than 10 minutes#N#G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes#N#G0437 intensive, greater than 10 minutes#N#These counseling services must be submitted with appropriate diagnosis coding to support medical necessity. The claim and documented encounter should include tobacco use status and confirmed tobacco-related diseases, as appropriate.#N#Example: A 67-year-old male Medicare patient presents with exacerbated COPD on oxygen. This patient continues to smoke one pack of cigarettes per day after several failed attempts at quitting. Approximately 15 minutes were spent counseling the patient in cessation techniques. He understands continuing to smoke could lead to stroke and death. The benefits of stopping were also presented to him. The patient has verbalized his desire to “give it another try.” He has set his own goal of 30 days to be completely smoke-free. We will follow up in two weeks to check progress.#N#CPT® coding:#N#99407#N#ICD-10-CM coding:#N#F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders#N#J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
What is the code for smoking cessation?
There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. 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.
Is 99407 an add-on code?
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling. Code.
