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

August 24, 2016
Medicare Web

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.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered. 

 

Related Topics: 
Ask the Expert