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Smoking Cessation

  1. Please clarify appropriate codes for smoking cessation services.

    Answer:
    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. Updated 6/9/2017
     
  2. 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 10 minutes) or intensive (more than 10 minutes) cessation counseling sessions for each attempt. Updated 6/9/2017
     
  3. 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. Updated 6/9/2017

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Smoking Cessation
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