- Coverage Criteria and Frequency Limits
- Checking Medicare Eligibility
- Top Tobacco Counseling Claim Errors
- Tobacco Cessation Telehealth Guide
- Overcoming Barriers to Tobacco Counseling
- Tobacco Counseling Documentation
- Clinical Guidelines and Recommendations
- Frequently Asked Questions
- Federally Qualified Health Center
- Rural Health Clinic
- Tobacco and Health Effects
- Benefits of Quitting
- Lung Cancer Screening
- Resources
Coverage Criteria and Frequency Limits
Table of Contents
- Counseling to Prevent Tobacco Use
- Diagnosis Coding
- Cost Sharing
- Reimbursement
- Nonparticipating Providers
- Related Content
Counseling to Prevent Tobacco Use
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 provider.
Medicare covers 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 twelve 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 twelve month period, begin with the month after the month the first Medicare covered counseling session was performed and count until eleven full months have elapsed.
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 services on the 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 a separately identifiable service.
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Related Content
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (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 10/9/2023