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Thread: Need help on CPT 99406..

  1. #1

    Default Need help on CPT 99406..

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    Hi all,

    We have a denial of CPT 94406 from BCBS billed with ICD 305.1 stating that bundled under another procedure done on the same DOS. On same date we billed another E/M code 99214 with modifier 25.

    Can anybody suggest me how to get the payement for this cpt. As per CMS guidelines this CPT should be billed 8 times in a calendar year. Does BCBS follow same gidelines?

    Please help me.

    Thanks a lot in advance.

    Prem kumar, CPC
    Last edited by prem_ponnuru; 03-07-2011 at 02:16 AM.

  2. #2
    Join Date
    Apr 2007
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    Stuart, Florida
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    Default

    So far from what I have read, the fact that the patient smokes is not enough, so 305.1, alone, will not get it paid. Again, just from what I have read so far, what I understand is that the patient must have a smoking-related illness. Anyway, I would try to find more info on what documentation is needed to bill for 99406/99407.

    I found some articles that may help you. Take a look.

    http://medbillingncoding.com/cpt-994...ion-counseling

    http://medbillingncoding.com/cpt-994...on-update-2010

    https://www.cms.gov/SmokingCessation/

    Hope this helps!
    Vanessa Mier, CPC

  3. #3

    Default BCBS Smoking Cessation Billing

    Quote Originally Posted by prem_ponnuru View Post
    Hi all,

    We have a denial of CPT 94406 from BCBS billed with ICD 305.1 stating that bundled under another procedure done on the same DOS. On same date we billed another E/M code 99214 with modifier 25.

    Can anybody suggest me how to get the payement for this cpt. As per CMS guidelines this CPT should be billed 8 times in the calendar year. Does BCBS follow same gidelines?

    Please help me.

    Thanks a lot in advance.

    Prem kumar, CPC
    Hi, Prem:

    Some of the Blues have established different methods of smoking cessation counseling. I'm not sure which state you are in, but if you check the website of your state's Blue, you will find the info needed. Some are only doing telephone counseling and others do have specific codes that need to be used or specific providers who are authorized to provide the service. If you are an PCP, and they only pay at approved providers, you can talk to your rep about having that code added to your contract.

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