Wiki Does Medicare still pay for Smoking Cessation 99406 and 99407?

CruzMich

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When I look this up with CMS it states "Smoking and Tobacco-Use Cessation Counseling - RETIRED"
I am in Primary Care, billing E/M 99214,with mod 25, 96372 (patient brings the meds from the pharmacy so I do not bill the medication) then there is 99406 utilizing F17200.
I am being flagged the ICD-10 for the smoking cessation not Medically Necessary.
When I tried to look it up through CMS it states RETIRED. I am requesting assistance please. We bill the 99214,25 with the 96372 monthly which isn't a problem.
 
When I look this up with CMS it states "Smoking and Tobacco-Use Cessation Counseling - RETIRED"
I am in Primary Care, billing E/M 99214,with mod 25, 96372 (patient brings the meds from the pharmacy so I do not bill the medication) then there is 99406 utilizing F17200.
I am being flagged the ICD-10 for the smoking cessation not Medically Necessary.
When I tried to look it up through CMS it states RETIRED. I am requesting assistance please. We bill the 99214,25 with the 96372 monthly which isn't a problem.

The Medicare patient website says that Medicare covers up to 8 counseling sessions in a 12 month period. https://www.medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-caused-disease

I'll have to dig a little further to look up the billing guidelines.

However, I do have one question. Is there a reason you're using the nicotine dependence, unspecified (F17.200) diagnosis code instead of the nicotine dependence, cigarettes (F17.210) for smoking cessation?
 
Found it in the Medicare claims processing manual. Here's the link - the tobacco counseling is in Chapter 32 - Billing Requirements for Special Services.

(BTW - the F17.200 is also listed in the chapter, so your DX should be fine either way. I was mostly just idly curious about the nicotine general vs cigarettes.)

Link to Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017downloads/R3848CP.pdf

Is it possible that this is a frequency limit issue? Up to 8 are covered in a 12 month period.
 
The Medicare patient website says that Medicare covers up to 8 counseling sessions in a 12 month period. https://www.medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-caused-disease

I'll have to dig a little further to look up the billing guidelines.

However, I do have one question. Is there a reason you're using the nicotine dependence, unspecified (F17.200) diagnosis code instead of the nicotine dependence, cigarettes (F17.210) for smoking cessation?
That was my question to the provider. He stated she vapes.
 
Being I am adding with the already E/M with mod25 due to the 96372 I shouldn't need any other modifier. For a while you didn't need a modifier, then you did...
IN the years we have seen this patient, we had never once billed smoking cessation.....
 
That was my question to the provider. He stated she vapes.

Ah, I see. This isn't what's causing your current, so I'm just pointing it out as more of an FYI: The correct code for vaping would be F17.290 (Nicotine dependence, other tobacco product).

The unspecified code F17.200 is saying that one doesn't know (or it isn't documented) what form of nicotine the patient uses. However, the provider does know - it's vaping.

F17.290 is saying that one knows what form of nicotine the patient uses, and it isn't cigarettes or chewing tobacco (the 2 forms that have their own specific code).

The CDC also mentions it in a coding bulletin, if your provider would like a source: https://www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf
 
IN the years we have seen this patient, we had never once billed smoking cessation.....

Is it possible that another provider has billed it? The up to 8 visits per 12 month period is a benefit limitation, so that would be total aggregate across all providers.

What is the exact denial/remark code you're receiving? That could help to determine the root of the issue.
 
Is it possible that another provider has billed it? The up to 8 visits per 12 month period is a benefit limitation, so that would be total aggregate across all providers.

What is the exact denial/remark code you're receiving? That could help to determine the root of the issue.
We utilize a system (terrible system) that is kicking the claim out for Medical Necessity and the ICD-10. I can usually find the information I need however with CMS I am finding it more dificult for some reason. You have been very helpful. The F17.290 is what I needed.
 
Ah, I see. This isn't what's causing your current, so I'm just pointing it out as more of an FYI: The correct code for vaping would be F17.290 (Nicotine dependence, other tobacco product).

The unspecified code F17.200 is saying that one doesn't know (or it isn't documented) what form of nicotine the patient uses. However, the provider does know - it's vaping.

F17.290 is saying that one knows what form of nicotine the patient uses, and it isn't cigarettes or chewing tobacco (the 2 forms that have their own specific code).

The CDC also mentions it in a coding bulletin, if your provider would like a source: https://www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf
Thank you! I absolutely appreciate your help.
 
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