Make a note of new smoking cessation codes

May 2, 2008

In 2008, new CPT codes were published for smoking and tobacco use cessation. The codes can be found in the Preventive Medicine section under Evaluation and Management (E&M) services.

In 2008, new CPT codes were published for smoking and tobacco use cessation. The codes can be found in the Preventive Medicine section under Evaluation and Management (E&M) services.

Smoking cessation counseling is a cost-effective way for busy oncologists to add revenue and serve their patients’ long-term healthcare needs. The two new codes are:

• 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.

• 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.

These codes should be used to report smoking/tobacco use cessation services provided on or after January 1, 2008. They replace the temporary healthcare common procedure coding system G-codes (G-0375 and G-0376) and are considered payable services by Medicare.

According to its National Coverage Determinations Manual, Medicare believes smoking and tobacco use cessation counseling to be “reasonable and necessary for a patient with a disease or an adverse health effect that has been found by the US Surgeon General to be linked to tobacco use, or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information.”

Medicare will currently cover two cessation attempts a year, and each attempt may include a maximum of four intermediate or intensive sessions. Therefore, a total of eight counseling sessions within a 12-month period will be covered by Medicare.

For cessation services provided in a second or subsequent year, the second/subsequent 12-month period is determined by counting 11 months starting with the month following the month in which the first covered cessation service was provided.

Private payer coverage may vary from Medicare coverage; therefore, it’s necessary for providers to check with the private payers in their area to determine if specific coverage requirements exist for these smoking cessation services.

It’s important to note that smoking and tobacco use cessation counseling services are considered to be face-to-face services and separate from E&M services when the counseling is greater than 3 minutes. Modifier -25 should be used with E&M services reported in conjunction with smoking/tobacco counseling services.