CPT Codes 99406-99407 (smoking cessation counseling) are not just for Primary Care Providers. Specialist providers can bill them as well. Follow the specific guidelines based on current procedural terminology and proper documentation requirements to avoid denials for a tobacco-use cessation counseling visit.
|99406||Smoking cessation counseling||3 – 10 minutes||Non-facility RVU – .45 ($15.11)|
|99407||Smoking cessation counseling||greater than 10 minutes||Non-facility RVU – .83 ($27.87)|
Current Conversion Factor: 33.58
Facts about the negative health effects of smoking
- The symptoms associated with smoking usually involve the respiratory, musculoskeletal, cardiovascular, and integumentary systems.
- Smoking changes the skin, teeth, and hair in ways that can add years to your physical appearance.
- Smoking chronically deprives the skin of oxygen and nutrients.
- The more than 4,000 chemicals in tobacco smoke may trigger the destruction of collagen and elastin leading to accelerated aging, lines, and wrinkles.
- Studies show that both men and women tend to develop thinner hair as they age and smoking can accelerate this process and suggest smokers are more likely to go bald.
- Additional studies show that smokers are at a greater risk of developing psoriasis.
Documenting and billing for 99406-99407: Time-based codes
- Use CPT® code 99406 and CPT® code 99407 for symptomatic or asymptomatic patients, for a tobacco cessation counseling visit.
- Document the time of the counseling spent face-to-face with the patient discussing smoking and smoking cessation.
- Add a diagnosis code (or codes) that describes the adverse effects of tobacco. These would include diseases such as atherosclerosis, chronic obstructive bronchitis, drug-induced alopecia (L64.0 with the nicotine dependence code), rhytides (L98.8), etc. if present.
- Use only the appropriate nicotine dependence code for an asymptomatic patient.
Components of the medical record documentation for 99406 and 99407
For each patient visit, document those that are applicable.
- Type or method of tobacco use (cigarettes, pipe, chewing tobacco, vaping, E-hookahs, vape pens, tank systems, modes, and ENDS, etc.)
- Amount of use (e.g., dependency)
- Impact (personal considering comorbidities)
- Affect (family, friends, health, social, financial, etc.)
- Methods and skills for cessation (e.g., behavior change intervention)
- Resources available
- Willingness to attempt to quit
- Agreement on a plan of approach
- Implementation date
- Method of follow-up
- Time spent with patient face-to-face
Documentation such as the one below will not support the billing of the smoking cessation service.
“I spent 11 minutes counseling the patient on tobacco use.”
ICD-10 Nicotine Dependence
Below are the ICD-10 codes for nicotine dependence.
|F17.20||Nicotine dependence, unspecified|
|F17.203||Nicotine dependence unspecified, with withdrawal|
|F17.208||with other nicotine-induced disorders|
|F17.209||with unspecified nicotine-induced disorders|
|F17.21||Nicotine dependence, cigarettes|
|F17.218||with other nicotine-induced disorders|
|F17.219||with unspecified nicotine-induced disorders|
|F17.22||Nicotine dependence, chewing tobacco|
|F17.228||with other nicotine-induced disorders|
|F17.229||with unspecified nicotine-induced disorders|
|F17.29||Nicotine dependence, other tobacco product|
|F17.298||with other nicotine-induced disorders|
|F17.299||with unspecified nicotine-induced disorders|
Frequency of use
According to the Medicare Benefit Policy Manual, Medicare Administrative Contractors (MACs) will allow payment according to the following frequency limits:
- Up to eight intermediate or intensive counseling sessions in 12 months.
- Eight intensive sessions in the subsequent year after a full 11 months of counseling has been performed.
- Up to two cessation attempts per year. (Four sessions per attempt equals eight sessions per year).
Medicare copayment, coinsurance, and deductibles for cessation counseling
Patient out-of-pocket expenses for smoking cessation counseling, such as those listed above, are waived. If collecting payments for any of the above at the time of service, be sure to carve out the allowable payment for codes 99406 and 99407 from other services provided on the same date of service.
Check with local insurance companies
Check with contracted commercial carriers on their policies for smoking-related services.
To understand how CMS determines allowables for CPT codes, go to:
Note: Be sure you use the following in typing in the site: research_reports
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