Coding for Tobacco Screening and Cessation

In 2014, the Patient Protection and Affordable Care Act (ACA) began requiring isurance plans to cover many clinical preventive services(www.healthcare.gov). Two of the covered preventive services include:

  • Tobacco use screening for all adults and adolescents
  • Tobacco cessation counseling for adults and adolescents who use tobacco, and expanded counseling for pregnant women

Government Payors

Medicare

Medicare Part B covers two levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate and intensive.

Two cessation attempts are covered per 12-month period. Each attempt may include a maximum of four intermediate or intensive counseling sessions. Therefore, the total annual benefit covers up to eight smoking cessation counseling sessions in a 12-month period.

The patient may receive another eight counseling sessions during a second or subsequent year once 11 full months have passed since the first Medicare-covered cessation counseling session took place.

For counseling to qualify for Medicare payment, the following criteria must be met at the time of service:

  • Patients must be competent and alert at the time of the counseling is provided.
  • Counseling must be provided by a physician or other Medicare-recognized health care professional.

Medicare no longer differentiates between symptomatic and asymptomatic patients as of October 1, 2016. Codes G0436 and G04037 were deleted that represented asymptomatic cessation counseling. According to the Medicare Preventive Services guide(www.cms.gov), Medicare suggests the use of codes 99406 and 99407.

Both symptomatic and asymptomatic patients are covered for care if they:

  • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
  • Are competent and alert at the time of counseling
  • Receive counseling furnished by a qualified physician or other Medicare-recognized practitioner.

A notable change as of October 1, 2016 is that the copayment/coinsurance as well as the deductible for 99406 and 99407 are now waived. The Medicare beneficiary has a zero dollar out-of-pocket liability.

HCPCS/CPT Code Type of Counseling Description
HCPCS/CPT Code : 99406Type of Counseling : IntermediateDescription: Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
HCPCS/CPT Code : 99407Type of Counseling : IntensiveDescription: Smoking and tobacco use cessation counseling visit is greater than 10 minutes
ICD-10 CM Diagnosis Code Description
ICD-10 CM Diagnosis Code : F17.200
Description: Nicotine dependence, unspecified, uncomplicated
ICD-10 CM Diagnosis Code : F17.201Description: Nicotine dependence, unspecified, in remission
ICD-10 CM Diagnosis Code : F17.210Description: Nicotine dependence, cigarettes, uncomplicated
ICD-10 CM Diagnosis Code : F17.211Description: Nicotine dependence, cigarettes, in remission
ICD-10 CM Diagnosis Code : F17.220Description: Nicotine dependence, chewing tobacco, uncomplicated
ICD-10 CM Diagnosis Code : F17.221Description: Nicotine dependence, chewing tobacco, in remission
ICD-10 CM Diagnosis Code : F17.290Description: Nicotine dependence, other tobacco product, uncomplicated
ICD-10 CM Diagnosis Code : F17.291Description: Nicotine dependence, other tobacco product, in remission
ICD-10 CM Diagnosis Code : T65.211ADescription: Toxic effect of chewing tobacco, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.212ADescription: Toxic effect of chewing tobacco, intentional self-harm
ICD-10 CM Diagnosis Code : T65.213ADescription: Toxic effect of chewing tobacco, assault
ICD-10 CM Diagnosis Code : T65.214ADescription: Toxic effect of chewing tobacco, undetermined
ICD-10 CM Diagnosis Code : T65.221ADescription: Toxic effect of tobacco cigarettes, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.222ADescription: Toxic effect of tobacco cigarettes, intentional self-harm
ICD-10 CM Diagnosis Code : T65.223ADescription: Toxic effect of tobacco cigarettes, assault
ICD-10 CM Diagnosis Code : T65.224ADescription: Toxic effect of tobacco cigarettes, undetermined
ICD-10 CM Diagnosis Code : T65.291ADescription: Toxic effect of other tobacco and nicotine, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.292ADescription: Toxic effect of other tobacco and nicotine, intentional self-harm
ICD-10 CM Diagnosis Code : T65.293ADescription: Toxic effect of other tobacco and nicotine, assault
ICD-10 CM Diagnosis Code : T65.294ADescription: Toxic effect of other tobacco and nicotine, undetermined
ICD-10 CM Diagnosis Code : T87.891Description: Personal history of nicotine dependence

Medicaid

Many states offer some payment for individual tobacco cessation and treatment counseling for Medicaid patients. For example, the ACA requires states to expand Medicaid coverage of cessation services for pregnant women. You are encouraged to contact your state Medicaid office for coverage information in your specific state.

The Centers for Medicare and Medicaid Services encourage state partners to support smoking cessation by ensuring coverage of all FDA-approved smoking cessation medication (prescription and over-the-counter [OTC]) without a copayment requirement or other financial barrier.


Private/Commercial Insurance Carriers

Private insurers are required to provide evidence-based tobacco cessation counseling and interventions to all adults and pregnant women. Private payer benefits are subject to specific plan policies. Check with individual insurance plans to determine what specific interventions are included and the extent to which these interventions are covered.

HCPCS/CPT CodeType of CounselingDescription
HCPCS/CPT Code: 99406Type of Counseling: IntermediateDescription: Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
HCPCS/CPT Code: 99407Type of Counseling: IntensiveDescription: Smoking and tobacco use cessation counseling visit is greater than 10 minutes
HCPCS/CPT Code: S9453Type of Counseling: Smoking cessation classesDescription: Non-physician provider, per session
HCPCS/CPT Code: 99381-99397Type of Counseling: Preventive medicine servicesDescription: Comprehensive, preventive evaluation based on age and gender to include appropriate history, examination, counseling/anticipatory guidance, risk factor reduction interventions, and related plan of care.
HCPCS/CPT Code: 99078Type of Counseling: Physician educational servicesDescription: Group setting (e.g., prenatal, obesity, diabetes)
ICD-10 CM Diagnosis Code Description
ICD-10 CM Diagnosis Code : F17.200
Description: Nicotine dependence, unspecified, uncomplicated
ICD-10 CM Diagnosis Code : F17.201Description: Nicotine dependence, unspecified, in remission
ICD-10 CM Diagnosis Code : F17.210Description: Nicotine dependence, cigarettes, uncomplicated
ICD-10 CM Diagnosis Code : F17.211Description: Nicotine dependence, cigarettes, in remission
ICD-10 CM Diagnosis Code : F17.220Description: Nicotine dependence, chewing tobacco, uncomplicated
ICD-10 CM Diagnosis Code : F17.221Description: Nicotine dependence, chewing tobacco, in remission
ICD-10 CM Diagnosis Code : F17.290Description: Nicotine dependence, other tobacco product, uncomplicated
ICD-10 CM Diagnosis Code : F17.291Description: Nicotine dependence, other tobacco product, in remission
ICD-10 CM Diagnosis Code : T65.211ADescription: Toxic effect of chewing tobacco, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.212ADescription: Toxic effect of chewing tobacco, intentional self-harm
ICD-10 CM Diagnosis Code : T65.213ADescription: Toxic effect of chewing tobacco, assault
ICD-10 CM Diagnosis Code : T65.214ADescription: Toxic effect of chewing tobacco, undetermined
ICD-10 CM Diagnosis Code : T65.221ADescription: Toxic effect of tobacco cigarettes, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.222ADescription: Toxic effect of tobacco cigarettes, intentional self-harm
ICD-10 CM Diagnosis Code : T65.223ADescription: Toxic effect of tobacco cigarettes, assault
ICD-10 CM Diagnosis Code : T65.224ADescription: Toxic effect of tobacco cigarettes, undetermined
ICD-10 CM Diagnosis Code : T65.291ADescription: Toxic effect of other tobacco and nicotine, accidental (unintentional)
ICD-10 CM Diagnosis Code : T65.292ADescription: Toxic effect of other tobacco and nicotine, intentional self-harm
ICD-10 CM Diagnosis Code : T65.293ADescription: Toxic effect of other tobacco and nicotine, assault
ICD-10 CM Diagnosis Code : T65.294ADescription: Toxic effect of other tobacco and nicotine, undetermined
ICD-10 CM Diagnosis Code : T87.891Description: Personal history of nicotine dependence

Self-Pay Patients and Uninsured Patients

Resources for patients who do not have insurance coverage or who have limited coverage by their insurance carrier include the following: