does cpt code 99406 need a modifier

These individuals who do not have signs or symptoms of tobacco-related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations. This is a question our experts keep getting from time to time. Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. Coding Information. 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. CPT is a registered trademark of the American Medical Association. Good Morning fellow coders, I would like to know your thoughts on billing 99406 (Smoking Cessation counseling 3-10 Min) when billing as an example the following codes today. When performed in conjunction with 30, 45, or 60 minutes of psychotherapy, it is strongly recommended that you track and document in the patients record the total face-to-face time with the patient, as well as the precise start and stop times spent specifically performing smoking and tobacco use cessation counseling. They would need to receive purchased doses and they would responsible for the $3.00 copay when they receive . Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. F17.211: Nicotine dependence, cigarettes, in remission All the articles are getting from various resources. Centers for Disease Control and Prevention P, Centers for Medicare and Medicaid Services:National Coverage Determination (NCD). Was a quit date set? These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. number of counseling attempts the patient has received from other providers) within the preceding 12-month period to ensure claims are not denied due to exceeding the individual patient frequency limit. Use tobacco and have been diagnosed with a recognized tobacco-related disease, 2. Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Designed by Elegant Themes | Powered by WordPress. Modifier -25 on 99406? G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes The ICD-10 codes diagnosis codes that should be reported for individuals who do not have signs or symptoms of tobacco-related disease individuals are: [MLN, 2015], F17.200: Nicotine dependence, unspecified, uncomplicated a CodingIntel membership, Last revised January 5, 2023 - Betsy Nicoletti Tags: screening and counseling for behavioral conditions. When a problem-oriented evaluation and management (E&M) service is performed on the same day by the same physician as a preventive visit, the modifier "-25" can be reported on the claim form. Effective September 30, 2016, HCPCS codes G0436 and G0437 are deleted. 3>. 99406, 99407 None SA, SB, GC, U1, U7, U9, 24, 25, 57, 99 . An emergency department visit (CPT code 99284 or 99285) or A clinic visit (CPT code 99205 or 99215); or Critical care (CPT code 99291); or Direct admission to observation reported with HCPCS code G0379, must be reported on the same date of service as the date reported for observation services. "13012p]8? CPT Code 99406 for New or Established Patient Counseling and or Risk Factor Reduction Intervention Services and more details about Behavior Change Interventions Individual Services . 2. Who are competent and alert at the time that counseling is provided; and JavaScript is disabled. You must log in or register to reply here. Assessing the patients readiness for change. When documentation supports that a significant, separately identifiable problem-oriented evaluation and management (E/M) service is rendered, the appropriate code for the E/M service may be reported separately. CPT Add-On Code +99354 Reimbursement Rate (2022): $ 140.26 Additional time up to 1 hour and 45 minutes for a diagnostic interview CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09 0 Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. From reading the policy for Amerigroup - Policy to procedure - it almost sound like they want one of these modifiers, but their definitions are not for a regular mds doing E/M visits. Such E/M service should be reported with modifier 25 to indicate it is separately identifiable from the tobacco use service. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017. iii Center for Behavioral Health Statistics and Quality. All the articles are getting from various resources. The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use. 99406 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes, 99407 Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes, F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A, and Z87.891. . There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. Claims are accepted for G0436 and G0437 with revenue codes 096X, 097X, or 098X when billed on TOB 85X Method II under the MPFS. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). X XX X X OCE MPFS DB 5878.2 Medicare systems shall recognize new CPT codes 99406 and 99407 for Smoking and Tobacco-Use Cessation I so sorry it took me a minute to get back to this. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. One more question - everything I can find from Amerigroup in relation to smoking cessation indicates they only allow 99407. In addition to the HCPCS code, these services must be billed with ICD-10 diagnosis code Z87.891 (personal history of tobacco use/personal history of nicotine dependence), ICD-9 diagnosis code V15.82. There two CPT Codes 99406 and 99407 that are used for tobacco cessation counseling for symptomatic individuals. APA is dedicated to improving population health, along with advocating for financial incentives that support psychologists involvement in these efforts. (Use for post-partum women who smoke). These new codes (effective on and after January 1, 2008) are: 99406 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and 99407 - Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes. It's free to sign up and bid on jobs. The Common Working File (CWF) maintains the number of smoking and tobacco-use cessation counseling sessions rendered to a beneficiary. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits. JavaScript is disabled. While assessing the patients health history, they report using commercial tobacco, smoking 1015 cigarettes each day. If this is your first visit, be sure to check out the. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered cessation session was performed. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness, February 2013. Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation. Does CPT code 99496 need a modifier? Each attempt may include a maximum of four (4) intermediate or (4) intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period. Services may be provided by a physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker. Patients diagnosed with mental and behavioral health disorders have higher rates of smoking as well as increased morbidity. NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed. Medicare denied cgaston said: Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. In 2016, 34.6% of adults with any mental illness reported current use of tobacco compared to 23.3% of adults with no mental illness.iiNearly 25% of adults in the United States have a mental health or substance use disorder (i.e., behavioral health condition), and these adults consume almost 40 percent of all cigarettes smoked by adults in the United States.iii, The most common causes of death among people with behavioral health conditions are heart disease, cancer, and lung disease, which can all be caused by smoking. We don't bill often for smoking cessation, but I've had good success from Medicare by billing 99406 to dx code Z71.6, with a mod -25 on the preceding E/M code. CPT Modifier 22 Increased Procedural Service Modifier 22 is used to describe an increased workload associated with a procedure. People with behavioral health conditions who smoke cigarettes are four times more likely to die prematurely than those who do not smoke. A patient requests an initial appointment for assistance with depressive symptoms and interpersonal difficulties. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. registered for member area and forum access, https://www.uhcprovider.com/content/UHCCP-Procedure-to-Modifier-Policy-R0119.pdf. Recent advocacy efforts by APA Services resulted in changes in NCCI edits which now allow psychologists to report smoking and tobacco use cessation counseling services (CPT codes 99406 or 99407) when performed at the same encounter as an individual psychotherapy session (codes 90832, 90834, and 90837). 99406 and 99407 are the remaining codes for tobacco cessation counseling. Reimbursement for smoking cessation counseling (SCC) must meet the following criteria: Services must be provided face-to-face. ONLY available for Medicaid-eligible pregnant females, women up to 6 months postpartum, and children and adolescents ages 10-21 who smoke. We don't bill often for smoking cessation, but I've had good success from Medicare by billing 99406 to dx code Z71.6, with a mod -25 on the preceding E/M code I've never had to bill a 99407, but I imagine there's nothing different compared to a 99406 D DeBillingTater Networker Local Chapter Officer Messages 32 Best answers 0 Feb 20, 2019 #3