Tobacco Cessation

Coverage Criteria and Frequency Limits

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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.

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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.

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Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

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Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

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Reviewed 10/9/2023