August 16, 2016
Counseling to Prevent Tobacco Use - Reminder
The Centers for Medicare and Medicaid Services (CMS) will cover intermediate and intensive counseling to prevent the use of tobacco. The service must be provided by qualified physicians/practitioners for outpatient and hospitalized Medicare beneficiaries who use tobacco.
Counseling to prevent tobacco use is a time-based service. The physician/practitioner's documentation must show the amount of time spent on each counseling visit.
- HCPCS Code G0436 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
- HCPCS Code G0437 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
- CPT Code 99406 – Smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes
- CPT Code 99407 – Smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes
Please note that minimal tobacco cessation counseling is already covered at each E/M visit.
For additional information, please refer to the following resources:
- Medicare National Coverage Determinations Manual – 100-03, Chapter 1, Part 4, Sections 210.4 and 210.4.1
- Medicare Claims Processing Manual – 100-04, Chapter 18, Section 150
- MLN Preventive Services Educational Tool
Reviewed 11.22.2021