icd 10 code for medicare smoking cessation

by London Murphy 4 min read

Reimbursement for Smoking Cessation
Medicare's average reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling, is $27.93. The 10-minute-or-longer consult may not apply to everyone. The 3-to-10-minute counseling code, 99406, reimburses at an average of $14.32.
Sep 9, 2019

Full Answer

What is the diagnosis code for smoking cessation?

There is 305.1 (tobacco dependence) or V15.82 (history of tobacco smoking). The ob/gyn doctors I work for have been using V15.82 even though the patient is still a smoker. To my understanding V15.82 is used for history of (no longer a smoker).

What is the ICD 10 code for smokeless tobacco?

Z72.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z72.0 became effective on October 1, 2021. This is the American ICD-10-CM version of Z72.0 - other international versions of ICD-10 Z72.0 may differ. Applicable To Tobacco use NOS Type 1 Excludes

What is the ICD 10 code for chronic smoker?

What is the ICD-10 code for chronic smoker? Z72. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. When do you code nicotine dependence? The provider must document the relationship between the nicotine dependence and the medical condition. This diagnosis code is the first-listed code ...

What is the CPT code medical hypnotherapy to stop smoking?

The Current Procedural Terminology (CPT) code 99401 as maintained by American Medical Association, is a medical procedural code under the range - Preventive Medicine, Individual Counseling Services. What is smoking cessation counseling?

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What is the CPT code for smoking cessation for Medicare?

99406Smoking Cessation Counseling Codes 99406 and 99407 Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.

How many times can you bill 99406?

A total of eight sessions are covered in a 12-month period. However, these limits do not apply to Paramount members as they are allowed an unlimited number of visits. Smoking cessation (99406 and 99407) services were developed as E/M services and may be reported with the E/M services 99201-99205 and 99211-99215.

What is code 1036F?

Patient Screened for Tobacco Use and Identified as a Tobacco Non-User. Performance Met: CPT II 1036F: Current tobacco non-user. OR. Tobacco Screening not Performed OR Tobacco Cessation Intervention not Provided for Medical.

Can 99406 be billed alone?

United Healthcare (UHC) indicates that reimbursement for smoking cessation counseling is available for all beneficiaries enrolled in their program. If billed alone, 99406 and 99407 are reimbursed. When billed with another evaluation and management code, the codes will bundle to a single fee.

What is the ICD-10 code for smoking?

Z72. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

Can 90471 and 99406 be billed together?

If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service.

What category is code 3120F?

Diagnostic/Screening Processes or ResultsThe Current Procedural Terminology (CPT®) code 3120F as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic/Screening Processes or Results.

Which code can be used for asymptomatic or physician's office for smoking and tobacco use cessation counseling visits for more than 10 minutes?

Note: G codes are for asymptomatic patient counseling in the physician office setting; C codes are for asymptomatic patient counseling in the hospital outpatient setting. ❖ 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.

How do I bill G0444 to Medicare?

New. G0444 is NOT able to be billed with G0402 (IPPE), but it can be billed with G0438 and G0439 as part of the the annual wellness visit. It cannot be performed with the IPPE, as it is a part of the IPPE and cannot be billed separately. You must perform the PHQ-9 not the PHQ-2 in order to bill the code.

What DX code covers 99406?

CPT code 99406 is used to report for smoking and tobacco cessation counseling requiring three to 10 minutes of time and CPT code 99407 for counseling requiring more than ten minutes.

Can you bill 99406 with G0439?

In addition, the following services can also now be billed when using audio only: Advance Care Planning (CPT 99497, 99498) Annual Wellness Visits (HCPCS G0438, G0439) Smoking Cessation Services (CPT 99406, 99407)

What is the CPT code 99406?

HCPCS/CPT Code Type of Counseling Description 99406. Intermediate. Smoking and tobacco use. cessation counseling visit is. greater than three minutes, but.

What is the CPT code for smoking cessation?

The CPT codes for billing for smoking cessation include: 99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes, up to 10 minutes. 99407 – Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.

How many cessation attempts are there for Medicare?

The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year. This is not per physician, or per attempt, but per patient.

How many people quit smoking in 2010?

In 2010, the American Cancer Society reported that 7 out of 10 smokers who desired to quit smoking were successful! It is possible to quit smoking with proper help from a physician who takes the time to counsel each patient on the benefits of quitting smoking, along with appropriate prescriptions, if necessary.

Can you downcode E&M level 5?

It would be like documenting a level 5 E&M code, but because the patient isn't ready to have a high-risk surgery, telling the physician you have to downcode your E&M, based on the patient’s readiness for surgery. The recommendation, discussion, and overall risk still exist. This would not negate the level 5 visit.

Does Medicare cover smoking cessation?

This means that Medicare and commercial insurance carriers must provide coverage for smoking cessation counseling and interventions. These services include: Tobacco use screening for all adults and adolescents. Tobacco cessation counseling for adults and adolescents who use tobacco, and expanded counseling for pregnant women.

Description Information

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

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