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

October 12, 2010 03:25 pm Sheri Porter

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(www.cms.gov) on how the expanded benefits should be reported.

In turn, the AAFP has developed resources to assist family physicians(142 KB PDF) as they provide tobacco cessation counseling.

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.

According to Hughes, family physicians should be aware that

  • from Aug. 25 to Dec. 31, 2010, tobacco cessation counseling for asymptomatic patients should be reported with the unlisted CPT code 99199 and
  • on or after Jan. 1, 2011, tobacco cessation counseling services provided to asymptomatic patients should be reported with the new health care common procedure coding system G-codes G0436 (tobacco-use counsel three to 10 minutes) and G0437 (tobacco-use counsel greater than 10 minutes). These services will be considered preventive services and patients will incur no out-of-pocket expenses.

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.