AAFP Resources Guide Members in Coding, Getting Paid for Tobacco Cessation Counseling

As of Aug. 25, a new group of patients became eligible for Medicare Part B benefits for tobacco and smoking cessation counseling. In response, the AAFP has created resources to help family physicians navigate Medicare coding for these services.

Previously, coverage for smoking cessation counseling was provided only for patients with a medical condition that was adversely affected by tobacco use. Now, however, coverage has been expanded to include counseling for patients who are asymptomatic, and CMS recently provided written instructions to its Medicare contractors (15-page PDF; About PDFs) on how the expanded benefits should be reported.

In turn, the AAFP has developed resources to assist family physicians as they provide tobacco cessation counseling for both groups of patients in 2010 and 2011.

According to Cynthia Hughes, C.P.C., an AAFP coding specialist, it is important for physicians to differentiate between counseling services not considered to be preventive and those considered to be preventive under new Medicare regulations beginning in 2011. Preventive services will not be subject to deductibles and co-insurance.

"Members need to understand the differences in both coding and payment for these services," Hughes told AAFP News Now. To that end, she has developed a table for members titled Smoking and Tobacco Cessation Counseling -- Medicare Part B Benefits 2010-2011 (1-page PDF; About PDFs) that includes timelines, coding information and descriptions of Medicare beneficiary coverage. "I strongly encourage members to download the table and keep it handy as a reference guide," said Hughes.

Hughes also has created an online document, Tobacco Cessation Counseling Benefits 2010-2011, that provides an overview of Medicare's new smoking cessation counseling benefits.

According to Hughes, family physicians should be aware that

In addition, currently and after Jan. 1, 2011, tobacco cessation counseling for patients who have signs or symptoms of tobacco-related disease should be reported with CPT codes 99406 and 99407. These services will continue to be subject to Medicare Part B deductible and coinsurance requirements.