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Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
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Related Articles
- Medicare Preventive Services Resource Guide
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Counseling to Prevent Tobacco Use
Smoking is the leading preventable cause of disease, disability and death in the United States. It harms nearly every organ in the body and causes about one in every five deaths.
Coverage for tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries include those:
- who use tobacco, regardless if they have signs or symptoms of tobacco-related disease,
- who are competent and alert at the time counseling is provided, and
- whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.
Coverage Criteria and Frequency Limits
Counseling to Prevent Tobacco Use
- Two individual tobacco cessation counseling attempts per year
- Each attempt may include a maximum of four intermediate or intensive sessions, with a total benefit covering up to eight sessions per year in a 12-month period:
- 99406: Intermediate – more than three minutes up to ten minutes
- 99407: Intensive – more than ten minutes
- To start the count for the second or subsequent 12-month period, begin with the month after the month the first Medicare covered counseling session was performed and count until 11 full months have elapsed
- Each attempt may include a maximum of four intermediate or intensive sessions, with a total benefit covering up to eight sessions per year in a 12-month period:
- Diagnosis coding
- F17.210, F17.211, F17.213, F17.218, F17.219, F17.220, F17.221, F17.223, F17.228, F17.229, F17.290, F17.291, F17.293, F17.298, F17.299, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A and Z87.891
- Additional ICD-10 codes may apply
- When clinically appropriate, medically necessary E/M same day as counseling to prevent tobacco use
- Use appropriate HCPCS code such as 99202–99215 to report E/M same-day service with modifier 25 to indicate separately identifiable service
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denial Reasons
- The information provided does not support the need for this service or item.
- Missing/incomplete/invalid diagnosis.
- Services cannot be paid because benefits are exhausted at this time.
- Benefit maximum for this time period or occurrence has been reached.
- Number of days or units of service exceeds acceptable maximum.
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Section 12
- CMS IOM Publication 100-03 Medicare National Coverage Determinations Manual, Part 4, Section 210.4.1
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 9/27/2024