Wiki Smoking Cessation 99406/99407

[aayers0624]

Medicare has denied smoking cessation codes 99406/99407 since 1/1/21 stating not medically necessary. According to the guidelines, we are meeting all of the documentation requirements and adding a modifier 25 to the E/M service on the same date of service. Is anyone else having this issue or are you able to get these codes paid?

 

[Mquick831]

What DX are you using. I use F17.210, this DX meets medical necessity.

 

[dama002]

Same as above I have always used z17.210. What is the reason for the denial

 

[erjones147]

I always add the Z71.6 code in addition to the F17.210 code

 

[suki_26]

I agree with DX. That we are aware of they will only pay on 3 codes....
F17.210 (cigarettes) F17.220 ( chew tobacco) F17.290 ( Other)

 

[tpkeith]

Wellcare has denied stating NCCI unbundled. The diagnosis is the same - F17.210. When searching PTP edits on CMS, there is no bundling issue. Anyone else have other ideas? How do you appeal when they say NCCI states something which is not there?

 

[suki_26]

we print out a copy of the LCD or NDC highlight and send it with the appeal. The fun thing we have found is that even if an insurance "follows medicare guidlines" ... if it is a commercial insurance they can follow those guidelines as loosely as they want to. Its getting kinda crazy

The only other thing I cam think is frequency, but you are allowed to bill it 8 times a year.
Here's the basics from MCR...

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4237CP.pdf