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Thread: 305.1 and Mdicare

  1. #1

    Exclamation 305.1 and Mdicare

    AAPC: Back to School
    I completely understand that code 305.1 is not sufficient for Medicare for smoking cessation and that you have to report the condition that patient has that is adversely affected by the tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.

    My question is this...do you also report 305.1 as a secondary diagnosis? The medicare guidelines do not direct you to use 305.1 as secondary that I can see, but I'm curious if others are reporting it this way and if Medicare is accepting it? Thanks.
    Last edited by dballard2004; 03-11-2011 at 02:31 PM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    North Carolina


    These individuals who do not have signs or symptoms of tobacco-related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations. The diagnosis codes that should be reported for these individuals are ICD-9 codes 305.1, non-dependent tobacco use disorder, or V15.82, history of tobacco use.


    Pages 3 & 12

  3. #3
    Join Date
    Apr 2007
    Stuart, Florida


    I'm unsure if these articles contain what you are looking for but, seeming that I answered someone elses smoking cessation question last week, I figured that you could read them and see if they include that information.


    Quote Originally Posted by ohn0disaster View Post
    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.




    Hope this helps!
    Vanessa Mier, CPC

  4. #4


    Thanks to both of you!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

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