Quick Guide: Billing for Smoking Cessation Counseling 99406 and 99407

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Quick Guide: Billing for Smoking Cessation Services

The American Cancer Society’s Great American Smoke Out  is a nationwide day, the third Thursday in November, dedicated to helping smokers stop smoking. So far, it has worked! There are now more former smokers in the Nation than current smokers.

When trying to quit smoking, support can make all the difference!   If your medical practice is already providing smoking cessation counseling and treatment, did you know you can bill and get reimbursed for your services?

 

Great American SmokeoutStats About Smoking

In 2010, 7 out of 10 smokers who desired to quit were successful! It is possible to quit smoking with proper help from your doctor. When smoking is stopped, for even one day, the human body reaps the benefits of overall better health and the decreased risk of cancer.

 

Helping Patients Stop Smoking

The American Cancer Society says that there are scientifically proven ways to stop smoking, and many medical practices may already be using them.

Effective treatments, according to the American Cancer Society include:

  • Seeing the doctor for advice on quitting
  • Counseling from a physician, group, or telephone
  • Prescription medications and nicotine patches
  • Former smokers report that nicotine gum or candies can help fight the urge, too.

One treatment may not work alone. Many people need a combination to quit once and for all.

Rapid Revenue Recovery Checklist

Can You Bill For Smoking Cessation Services?

In 2014, smoking cessation became a covered benefit under the Affordable Care Act (Obamacare). This means that Medicare and commercial insurance carriers must provide smoking cessation counseling and interventions. These services include:

  • Tobacco use screening for all adults and adolescents
  • Tobacco cessation counseling for adults and adolescents who use tobacco, and expanded counseling for pregnant women

 

Who Is Covered?

For a Medicare patient to qualify for smoking cessation counseling they must meet the following requirements:

  • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
  • Patient must be competent and alert at the time of counseling.
  • Counseling must be provided by a qualified physician or other Medicare-recognized healthcare provider.

 

Smoking Cessation Counseling Codes 99406 and 99407

Reimbursement may be possible if you bill the patient’s insurance company correctly. Medicare covers 2 cessation attempts per 12-month period.  Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.

The CPT codes are listed below for billing 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

A modifier 25 may be appropriate to append to the primary E/M visit code.

Note that as of September 30, 2016 HCPCS codes G0436 and G0437 for smoking cessation have been deleted.

Some commonly used ICD-10 diagnosis codes used, if appropriate given your patient’s situation, may include:

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

Z87.891 Personal history of nicotine dependence

Though the billing codes are relatively simple, there are rules to follow when billing Medicare based on the patient’s symptoms.

The Medicare Learning Network from CMS provides information that may be helpful.

Check with your local Medicare carrier or private insurance company for their rules and requirements before billing for smoking cessation.

 

Documentation Requirements

The documentation in the medical record must support the billing of the cessation code.  The documentation needs to record what was discussed during counseling and should show a significant and separately identifiable service.

Items to document may include to following elements:

  • The patient’s tobacco use
  • Advised to quit and impact of smoking
  • Assessed willingness to attempt to quit
  • Providing methods and skills for cessation
  • Medication management of smoking session drugs
  • Resources provided
  • Setting quit date
  • Follow-up arranged
  • Amount of time spent counseling patient

An entry in the patient’s health record simply stating that the doctor spent 11 minutes counseling the patient on tobacco use will not cut it and will not meet the standard for medical necessity or to be able to bill the codes.

 

Reimbursement for Smoking Cessation

Are you losing money by not coding and billing for smoking cessation? 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 $27.93.

The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $14.32. These are national reimbursement amounts, your local Medicare payments may vary.

99406 = $27.93

99407 = $14.32

For Medicare co-insurance and deductibles are waived.

 

Where Can Smokers Get Additional Help?

A couple of resources your doctor can provide to their patients are: The American Lung Association hosts the Freedom From Smoking group that helps coach the smoker to quit. They offer free support and tools to get the person to stop smoking.

The CDC mentions calling 1-800-QUIT-NOW (1-800-784-8669). This can help if the patient is not computer savvy, but wants help. They will also give free support and advice, developing a plan that’s right for the patient.

Steps to helping our patients become smoke-free are reimbursed by many insurance companies. Beyond getting paid for the counseling, patients will give you credit for helping them start their journey to a smoke-free, healthier life.

Quitting isn’t easy, so make sure your patients know how much you support them every step of the way!

Is your practice billing for smoking cessation? Let me know in the comments.

 

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34 Responses to “Quick Guide: Billing for Smoking Cessation Counseling 99406 and 99407”

  1. i was a smoker few years back i had a addiction i was addicted to smoking then i start vaping and eventually i stop smoking and now i feel so much better believe me vaping is so much better then smoking.

    Reply
  2. We charged a 99214 (25 mod), 99406, and pneumo vaccine 90732, 90471. The smoking cessation code is being denied even when we tried using a modifier 59. Do you have any pointers for me? I noticed this question has been asked before but do not see a reply. Your advice would be greatly appreciated.

    Thank you.

    Reply
  3. I have billed a claim for 99214 and 99406. Insurance (not Medicare) denied saying we can’t bill them together. Is there a modifier that can be used with one of these codes or does the ” not on same visit” apply to commercial Insurance also?

    Reply
    • Lee, we would append modifier 25 to the office visit and make sure the diagnosis codes were different. Of course, it is up to the payer if they will pay both codes regardless of how the visit is coded. CHeck with whoever the carrier is in your locality for billing guidelines.

      Reply
  4. Does anyone know how to bill smoking cessation counseling to Medicaid? I’ve been told that the 99406 is not payable for an inpatient setting. Is there a CPT code for smoking cessation that is?

    Reply
    • LaToya that is going to vary state by state. I would check to see if there is any info on your state’s Medicaid website on how to bill for smoking cessation.

      Reply
  5. I just learned from Medicare that EM services cannot be billed on the same day as tobacco counsel. It is always bundled, so in effect have the patient come in on a separate day.

    Reply
    • Some doctors do split up the visit. I heard of one doctor that was a rheumatologist. At the patient visit if the patient needed a bone density scan he would have them come back on another day. He had a scanner in his office. When the patient came in for the scan the doctor told the patient to make another appointment to go over the results. The patient now has come back to the office for 3 visits and has taken time off of work 3 times, when it all could have been done in just one visit. The doctor was paid for all 3 dates of service when it was done in this fashion. He would not have been paid for all the services if they were done on the same day. Bad customer service. That’s just nuts!

      Reply
  6. I billed for smoking cessation counseling and accepted assignment on the same day as a 99214 visit. I mistakenly used modifier 25 next to the counseling, but the visit was non assigned and I neglected to use mod 25 for the visit. Even tho I billed months later for the counseling, Medicare went back and bundled the psyment so I got paid for the counseling, but the patient did not get paid for the visit. I subsequently rebilled non accept for the patient visit and await cms decision. Should I have the patient appeal my error? Do you think Medicare will look kindly on my revised claim, which included mod 25 next to the visit?

    Reply
    • I would send in a corrected claim if I believe it to be appropriate. I believe as long as the documentation supports the claim, bill it.

      Reply
  7. Typo in my comment – should have said 99406 (not 99046)

    I should also mention that my question pertains to Medicare. My contractor is NGS.

    Please help I am so frustrated!

    Thanks!!

    Reply
  8. Hello,

    I work for primary care practice and we are billing 99046 & 99407 with diagnosis Z17.200 – I am getting denial CO-50 not medically necessary. Also M64 – missing/incomplete/invalid other diagnosis. What am I missing here? I know that the G codes are no longer in use. Some patients are symptomatic, some are not. All literature I can find shows that you can bill regardless of symptoms. I do not find any clear guideline on this that suggests multiple diagnoses must be used. HELP!

    Reply
  9. You show the documentation requirements for the tobacco cessation counseling. Can you provide me with a source link that states that those are requirements and not just “recommended”. I’ve looked all over Medicare website but cannot locate where it provides the specifics on documentation requirements. Thank you.

    Reply
  10. Thanks for the article, Manny. In the statement Counseling must be provided by a qualified physician or other Medicare-recognized healthcare provider, who can provide this? Can an LICSW do so? Or does it have to be MD/DO?

    Reply
  11. Would I need a modifier on the 99406/99407 when billing in addition to 99203/4 or 99212/3/4 when adding modifier 25 to the E&M code? For example, 99204 – 25, 99406 – 59?

    Reply
    • No, we typically would not use any additional modifier – just the -25 appended to the E/M. However, if additional services were provided at the time of service then the -59 modifier might apply. For example, if the patient came in for an office visit, smoking cessation and an additional treatment such as an EKG then we would append modifier -59 to the EKG in this sample case.

      Reply
  12. I am trying to bill 99406 with a telemed office code of 99214 and q3014. The 99214 and q3014 must have a gt modifier for Medicaid to pay it but what do I put next to the 99406? Does that need a gt modifier as well and should I put an additional modifier of 25 on the CPT 99214 code

    Reply
    • I would add the modifier –GT to ALL services that were provided via telemedicine. Also I would bill out the 99214 with the modifier -25 if also billing out for the 99406. Be sure that the diagnosis code for either nicotine dependence unspecified F17.200 or history of tobacco use Z87.891 is utilized with the smoking cessation code to indicate the reason for the smoking cessation. Check with your local Medicare carrier on exactly how they need claims like these billed.

      Reply
  13. Use of 99406 has been denied if another service like admin of flu shot done on same day as office visit. We use for ex. 99213 w 25 modifier, then 36415 (lab draw), 90471 (imm. admin), 90686 (flu vaccine), and 99406 (tobacco counseling). We have tried this various ways but still unsuccessful. Is there a particular modifier to add when doing an office visit, giving flu shot, and tobacco counseling in same day.

    Reply
    • I am having this issue as well. We charged a 99396 (25 mod), 99406, and pneumo vaccine 90732, 90471. The smoking cessation code is being denied. I added a 59 mod to it and appealed, but it is still denying. Do you have any pointers for me?

      Reply
  14. We tried to bill for pts. that are in obvious need -with COPD, atheroscler. changes in blood vsls and with all corr. codes but got denied as -“not med. neccessary”. So how we prove it is actually more than needed?? We added it to 99213 with mod 25 but it was denied. What is the secret?

    Reply
  15. Thanks,Manny it is really helpful for me and I really appreciate you for sharing this information. I have one more question which is not related to this, but I hope you have the answer as per medicare guidelines G0246, G0477 etc are not payable at medicare I just need the correspondence codes for these services.they told me to rebill the claim with the correct code.

    Reply
      • no, medicare is the primary and we billed with the 99214 so it is denied stating bundled with the 99214. so is there is any other for this one?

        Reply
        • The G0246 cannot be billed with a 99214 per Medicare guidelines. Looks like some elements of G0246 overlap with the E/M code so Medicare says no.

          G0246 – Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy
          resulting in a loss of protective sensation (LOPS) to include at least the following: (1) a patient history, (2)
          a physical examination that includes: (a) visual inspection of the forefoot, hindfoot, and toe web spaces,
          (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of
          vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient
          education

          Reply
  16. Hi Manny,
    I hav been using these codes for a few years now. The reimbursement certainly adds up over time.
    I attended a conference last year that was encouraging this counseling during the Medicare annual wellness exam. They also encouraged using the othe counseling codes of appropriate covering alcohol abuse, STD counseling, obesity counseling. What’s your take on this?
    Is there a best time or type of visit to use this code like new visit or follow up?
    Your postings are much appreciated.
    Rodney Muhammad DO

    Reply
    • It is my understanding that chiropractors can bill for smoking cessation. Check with your insurance carriers for their specific rules.

      Reply
  17. Can these codes be billed for e-cigarette used as long as the provider documents nicotine dependence, since e-cigarettes may or may not contain nicotine?

    Reply
    • I recall reading somewhere that e-cigarettes don’t count for smoking cessation. I would suggest checking with the insurance carrier policies to see if they would cover the service in this case.

      Reply

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