Q&A: Which Codes Are Used to Report Smoking Cessation Counseling?

Q: We provide tobacco cessation services and have been reporting these with the following HCPCS codes:

• G0436, smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than three minutes, up to 10 minutes
• G0437, smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

There are also CPT® codes for these services. Which is the appropriate set of codes to use for Medicare?

A: The HCPCS codes for tobacco cessation were created in 2011 to report the counselling services being provided to Medicare beneficiaries. The CPT codes for these services have slightly different descriptions:

• 99406, smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes
• 99407, smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

As of October 1, 2016, CMS is removing G0436 and G0437 from the I/OCE so they will no longer be processed on outpatient claims.

All of the codes are status indicator S (significant procedure/service). However, it is interesting to note that while G0436 and 99406 are both assigned to APC 5821, G0437 is assigned to APC 5822 and 99407 is assigned to APC 5821. There is a difference in the national unadjusted payment for these APCs: APC 5821 is $27.12, while APC 5822 has a national rate of $69.65. So for sessions lasting longer than 10 minutes, there will be approximately a $42 reduction in reimbursement.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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