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Counseling to Prevent Tobacco Use

Effective 9/30/2016, HCPCS codes G0436 and G0437 are deleted. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits.

HCPCS/CPT Codes

  • 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

ICD-10 Codes: F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, 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

  • NOTE: Additional ICD-10 codes may apply. If the patient has developed a medical condition due to tobacco use, that may be the additional ICD-10 codes that apply.Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer. Smoking is estimated to increase the risk.
  • For coronary heart disease by 2 to 4 times
  • For stroke by 2 to 4 times
  • Of men developing lung cancer by 25 times
  • Of women developing lung cancer by 25.7 times

Who Is Covered

Outpatient and hospitalized Medicare beneficiaries for whom all of the following are true:

  • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
  • Competent and alert at the time of counseling
  • Counseling furnished by a qualified physician or other Medicare-recognized practitioner

Frequency

Two cessation attempts per year. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions per year.

Medicare Beneficiary Pays

  • 99406 and 99407: Copayment/coinsurance and deductible waived
Counseling to Prevent Tobacco Use
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