Medicare is a federally run program, which means it has a uniform set of rules that apply across the entire country. On the other hand,
Medicaid is state-based, meaning the program is a hodge-podge of rules and requirements that vary from state to state so you would likely need to check your state rules.
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.
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.
How do you bill for smoking cessation counseling? Who's covered? Who can perform the service? What codes should be used? Are there documentation requirements? How much does it reimburse? Billing 99406 and 99407 is simple if you have the all the information.
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