- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
Smoking Cessation
- Please clarify appropriate codes for smoking cessation services.
Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco-use cessation counseling visits. - Please clarify what constitutes a session which includes four attempts and two sessions allowed. Does this mean we can bill eight separate DOS for smoking cessation?
Answer: Medicare will allow eight visits annually in a 12-month period. Two individual tobacco cessation counseling attempts are permitted 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 per for a Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than three minutes up to ten minutes) or intensive (more than ten minutes) cessation counseling sessions for each attempt. - Please clarify whether modifier 25 should be attached to an E/M service associated with smoking cessation.
Answer: Medicare will allow payment for a medically necessary E/M service on the same date as tobacco cessation counseling, provided it is clinically appropriate and medically necessary. Such E/M service should be reported with modifier 25 to indicate it is separately identifiable from the tobacco use service. Modifier 59 would not be appropriate in this instance. - Please clarify whether tobacco cessation counseling may be billed at the same time as the AWV and the IPPE.
Answer: CPT codes 99406 and 99407 are separately payable on the same day as the AWV and IPPE. No modifier is required. - Please clarify if tobacco counseling can be billed if the patient is not ready to quit, or is not successful.
Answer: CPT codes 99406 and 99407 may be used for smoking and tobacco use cessation counseling visits when the qualified physician or other Medicare-recognized practitioner provides any intermediate or intensive smoking cessation counseling services, regardless of whether or not the patient chooses to quit or is successful. - Please clarify whom the Medicare recognized practitioners are that can furnish tobacco counseling services.
Answer: The applicable providers are; physicians, nurse practitioners, physician assistants, clinical nurse specialists, clinical psychologists, and clinical social workers.
When these services are provided by a clinical nurse specialist in the RHC/FQHC setting, they are considered “incident to” and do not constitute a billable visit. Per Decision Memo for Counseling to Prevent Tobacco Use (CAG-00420N):
CMS can only cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries furnished by a qualified physician or other Medicare-recognized practitioners. Certified tobacco cessation specialists, pharmacists, registered nurses, chemical dependency counselors, health educators, and respiratory therapists are not recognized in the law as qualified Medicare Part B practitioners for furnishing counseling services. In the case of pharmacists, these health professionals may qualify as durable medical equipment suppliers for Medicare beneficiaries, but this type of Medicare supplier is not recognized as a qualified provider or supplier of counseling services. - Please clarify what type of documentation should be included with tobacco counseling.
Answer: Proper documentation for tobacco use counseling should include the total time spent face-to-face with the patient, and what was discussed. Documentation must always include sufficient detail to support the claim.
As with any claim, Medicare may decide to conduct post-payment review to determine that the services provided are consistent with coverage instructions. Providers must keep patient record information on file for each Medicare patient for whom a counseling claim is made. These medical records can be used in any post-payment review and must include standard information along with sufficient patient histories to allow determination that the steps required in the coverage instructions were followed. - Please clarify if there are any frequency requirements associated with tobacco counseling. For example, would it need to be completed once a week, monthly, or yearly?
Answer: There are no weekly or monthly frequency requirements related to how often during the 12-month period the counseling is furnished. Contractors shall only pay for eight counseling to prevent tobacco use sessions in a 12-month period. The beneficiary may receive another eight sessions during a second or subsequent year after 11 full months have passed since the first Medicare-covered counseling session was performed. To start the count for the second or subsequent 12-month period, begin with the month after the month in which the first Medicare-covered counseling session was performed, and count until 11 full months have elapsed.
Reviewed 10/8/2024