Effective for services furnished on or after March 22, 2005, a National Coverage Determination (NCD) provides for coverage of smoking and tobacco-use cessation counseling services. Conditions of Medicare Part A and Medicare Part B coverage for smoking and tobacco-use cessation counseling services are located in the Medicare National Coverage Determinations Manual, Publication 100-3, section 210.4.
HCPCS and Diagnosis Coding
The following HCPCS codes should be reported when billing for smoking and tobacco- use cessation counseling services:
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
Note the above codes are payable for dates of service on or after January 1, 2008. Codes G0375 and
G0376, below, are not valid or payable for dates of service on or after January 1, 2008.
G0375 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Short Descriptor: Smoke/Tobacco counseling 3-10
G0376 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes
Short Descriptor: Smoke/Tobacco counseling greater than 10
Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS code .such as HCPCS 99201– 99215, to report an E/M service with modifier 25 to indicate that the E/M service is a separately identifiable service from G0375 or G0376.
Contractors shall only pay for 8 Smoking and Tobacco-Use Cessation Counseling sessions in a 12-month period. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered cessation 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 cessation session was performed and count until 11 full months have elapsed.
Billing and Coding Guidelines
Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407). If you bill using the former HCPCS codes (G0375 and G0376) for services provided after December 31, 2007, your claims will not be paid.
• 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and
• 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes.
CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December31, 2007.
They are being replaced by two new CPT codes (99406 – Smoking and tobaccouse cessation counseling visit; intermediate, greater than 3 inutes up to 10.
Optum will align reimbursement with Medicare including up to 2 attempts of up to 4 sessions each for a total of up to 8 face-toface visits during a 12-month period for individuals who use tobacco – regardless of whether there are signs or symptoms of tobacco-related disease. These visits must be provided by a qualified health care provider.
The diagnosis codes that should be reported for individuals who do not have signs or symptoms of tobacco-related disease individuals are:
• ICD-9 code 305.1 (non-dependent tobacco use disorder)
• ICD-9 code V15.82 (history of tobacco use)
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Medicare also allows for the reporting an E/M visit (99201-99215) in addition to the tobacco-counseling, if modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the E/M [Phurrough].
NCCI Edit
The below CPT codes are not paid seperately unless specific modifier used.
0359T 0360T 0361T 0362T 0363T 0364T 0365T 0366T
0367T 0368T 0369T 0370T 0371T 0372T 0373T 0374T
92531 92532 94002 94003 94004 96101 96102 96103
96105 96118 96119 96120 96125 96127 96155 99172
99173 99408 99409 G0396 G0397 G0442 G0443 G0444
CAUTION – What You Need to Know
CR 5878, from which this article is taken, announces that the 2008 Medicare Physician Fee Database (MPFSDB) includes two new CPT codes for smoking and tobacco use cessation counseling services; replacing the temporary HCPCS G codes (G0375 and G0376) currently in use for billing these services. These new codes (effective on and after January 1, 2008) are:
• 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and
• 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes.
GO – What You Need to Do
Make sure that your billing staffs are aware of these newly required CPT codes for smoking and tobacco use cessation counseling services.
You should also review CR6163 (http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/R1593CP.pdf),
which removes the outpatient physical therapy provider (OPT) bill type 74X and comprehensive outpatient rehabilitation facility (CORF) bill type 75X from the list of applicable bill types for smoking and tobacco cessation counseling (effective July 1, 2008). The related MLN Matters® article may be found at http://www.cms.gov/Outreachand-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM6163.pdf on the CMS website.
CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December 31, 2007.
They are being replaced by two new CPT codes (99406 – Smoking and tobaccouse cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes). These new CPT codes, which are included in the 2008 Medicare Physician Fee Database (MPFSDB), become effective for claims with dates of service January 1, 2008 and later.
FIs, carriers, and A/B MACs will pay for counseling services billed with HCPCS codes G0375 and G0376 for dates of service performed on and after March 22, 2005 through Dec. 31, 2007 and with CPT codes 99406 and 99407 for dates of service on or after January 1, 2008.
Billing and Payment for Alcohol and/or Substance Abuse Assessment and Intervention Services
For CY 2008, the Procedure Editorial Panel has created two new Category I Procedure codes for reporting alcohol and/or substance abuse screening and intervention services. They are Procedure code 99408 (Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes); and Procedure code 99409 (Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes). However, screening services are not covered by Medicare without specific statutory authority, such as has been provided for mammography, diabetes, and colorectal cancer screening. Therefore, beginning January 1, 2008, the OPPS recognizes two parallel G-codes (HCPCS codes G0396 and G0397) to allow for appropriate reporting and payment of alcohol and substance abuse structured assessment and intervention services that are not provided as screening services, but that are performed in the context of the diagnosis or treatment of illness or injury.
Contractors shall make payment under the OPPS for HCPCS code G0396 (Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes) and HCPCS code G0397, (Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and intervention greater than 30 minutes), only when reasonable and necessary (i.e., when the service is provided to evaluate patients with signs/symptoms of illness or injury) as per section 1862(a)(1)(A) of the Act.
HCPCS codes G0396 and G0397 are to be used for structured alcohol and/or substance (other than tobacco) abuse assessment and intervention services that are distinct from other clinic and emergency department visit services performed during the same encounter. Hospital resources expended performing services described by HCPCS codes G0396 and G0397 may not be counted as resources for determining the level of a visit service and vice versa (i.e., hospitals may not double count the same facility resources in order to reach a higher level clinic or emergency department visit). However, alcohol and/or substance structured assessment or intervention services lasting less than 15 minutes should not be reported using these HCPCS codes, but the hospital resources expended should be included in determining the level of the visit service reported.
