Most practice offices knows that effective on and after August 25, 2010, Medicare pays for claims that covers tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries. This article is focused more on Medicare’s coverage for counseling session to prevent tobacco use for;
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.
These individuals who do not have signs or symptoms of tobacco-related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations (see below).
The ICD-9 diagnosis codes that should be reported for these individuals are:
305.1 (non-dependent tobacco use disorder)
ICD-10 Codes Effective October 01, 2015
F17.200: Nicotine dependence, unspecified, uncomplicated
F17.201: Nicotine dependence, unspecified, in remission
F17.210: Nicotine dependence, cigarettes, uncomplicated
F17.211: Nicotine dependence, cigarettes, in remission
F17.220: Nicotine dependence, chewing tobacco, uncomplicated
F17.221: Nicotine dependence, chewing tobacco, in remission
F17.290: Nicotine dependence, other tobacco product, uncomplicated
F17.291: Nicotine dependence, other tobacco product, in remission
V15.82 (history of tobacco use)
The ICD-10 Codes Effective October 01, 2015
Z87.891: Personal history of nicotine dependence
In 2011, Medicare added two new G codes for billing for tobacco cessation counseling services to prevent tobacco and for asymptomatic individuals 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.
Use HCPCS Codes to Use: (for Asymtomatic Individuals for Medicare)
G0436: Smoking and tobacco cessation counseling visit forthe asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes,
G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
*** FREQUENCY: It allows 2 cessation counseling session attempts per 12-month period, with maximum of 4 intermediate or intensive sessions per attempt (8 Sessions per 12 Months Period). After eight sessions within the year, additional sessins are allowed only after 11 months since the first covered cessation counseling session.
*** WAIVED: Eligible beneficiaries are covered under Medicare Part B. Both the coinsurance and deductible are waived.
CPT Codes to Use for your Symptomatic Patients and for Non-Medicare Payors
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
“Medicare will allow payment for a medically necessary Evaluation and Management (E/M) service on the same date as tobacco cessation counseling, provided it is clinically appropriate. Such E/M service should be reported with modifier 25 to indicate it is separately identifiable from the tobacco use service.”
*** Append your Modifier 25 on your E/M Code (for example 99213-25)