does cpt code 99406 need a modifier

There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. These codes group to APG 451. Diagnosis codes should reflect the condition the patient has that is adversely affected by tobacco us, or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. 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. Therefore, contractors shall advise non-outpatient perspective payment system (OPPS) providers to use unlisted code 99199 to bill for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010. Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding (Rev. Has anyone had success with these codes? Integrating smoking and tobacco use cessation counseling services into routine practice is one way that psychologists can address population health and be reimbursed for those services. On January 3, 2011, contractors systems will accept the new G codes for services performed on or after August 25, 2010. This change to be effective 7/1/2010: The procedure code is inconsistent with the modifier used or a required modifier is missing. hbbd```b``]":A$-"` f^&9"|0{ f7 \D20fI v;w \ If this is your first visit, be sure to check out the. Institutional claims billed on TOBs other than 12X, 13X, 22X, 23X, 34X, 71X, 77X, or 85X will be returned to the provider. Its complete definition, defined by the American Medical Association Current Procedural Terminology 2012, is "a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. For a better experience, please enable JavaScript in your browser before proceeding. 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. If the problem-oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not . 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 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes, (Rev. Privacy Policy, Relevant Search Terms:smoking cessation; tobacco counseling, 99406 99407, Get Unlimited Access to CodingIntels Online Library, screening and counseling for behavioral conditions, Code Prolonged Services with Confidence | Webinar, Are you missing the initial annual wellness visit? 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. You are using an out of date browser. However, these limits do not apply to Paramount members as they are allowed an unlimited number of visits. The counseling during an E/M service must be either intermediate or intensive. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. 99217 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and . CMS does not currently have specific training requirements, but may in the future. a CodingIntel membership, Last revised January 5, 2023 - Betsy Nicoletti Tags: screening and counseling for behavioral conditions. You must log in or register to reply here. CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period. Quitting smoking can improve mental health and substance use disorder recovery outcomes.iii,iv,v,vi,viii,ix Tobacco smoke can interact with and inhibit the effectiveness of certain medications taken by patients with behavioral health conditions, often resulting in the need for higher medication doses to achieve the same therapeutic benefit.iv Although often not the primary presenting problem for which patients seek out psychological assistance, the disproportionate rates of smoking among individuals living with mental health difficulties uniquely poises psychologists to effectively reach more individuals with this life-saving intervention. When medically indicated, this additional E/M service is subject . Verification of the patients history of tobacco use. As with any claim, Medicare may decide to conduct post-payment reviews to determine that the services provided are consistent with coverage instructions. Effective September 30, 2016, HCPCS codes G0436 and G0437 are deleted. Intensive counseling is 4 sessions of more than 10 minutes each. Amerigroup has been unable to tell you specifically which policy they are applying to your claim? By entering the beneficiarys health insurance claim number (HICN), providers have the capability to view the number of sessions a beneficiary has received for this service via inquiry through CWF. There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. Services may be provided by a physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker. F17.211: Nicotine dependence, cigarettes, in remission Now, we have got the complete detailed explanation and answer for everyone, who is interested! Claims are accepted for G0436 and G0437 with revenue code 052X when billed on TOBs 71X or 77X. Patient has WC and Medicare insurance? At the 43-minute mark, you spend five minutes assessing their smoking habits, understanding of health risks, and readiness to quit. 2527 0 obj <>stream CPT codes for placement of these devices are not separately reportable. The following HCPCS codes should be reported when billing for counseling to prevent tobacco use effective January 1, 2011: G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes Short descriptor: Tobacco-use counsel 3-10 min G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes Short descriptor: Tobacco-use counsel >10min. Probably the only X modifier to use would be the XU and that's basically like reporting the 59 modifier. Append modifier 25 to the service code selected to indicate that a separately identifiable E/M service was provided on the same date of service as the counseling service." 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. 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. Report only one of the codes, depending on the time of the counseling. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. Modifier -25 on 99406? Vital Signs: Current Cigarette Smoking Among Adults Aged 18 Years With Mental IllnessUnited States, 20092011. F17.210: Nicotine dependence, cigarettes, uncomplicated 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 If I add a 59 modifier it denies as procedure inconsistent with the modifier used/required modifier missing. 7133-04.4.2 CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period. There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. If this is your first visit, be sure to check out the. or anyone else have this same issue? Z87.891: Personal history of nicotine dependence. It's free to sign up and bid on jobs. So my first thought was ok, let's find the cert and delete it and reboot the node, as Failover Cluster will get the cert back from the other nodes when trying to join the cluster. CPT. F17.290: Nicotine dependence, chewing tobacco, uncomplicated Morbidity and Mortality Weekly Report 2013;62(05):81-7. vii NIH State-of-the-Science Panel. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables.pdf. ), Remittance Advice Remarks Code (RARC) M64 (Missing/incomplete/invalid other diagnosis), and Group Code PR assigning financial liability to the beneficiary if a claim is received with a signed Advance Beneficiary Notice (ABN). Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. 99214 should be used for patients whose appointments are 25 minutes and whose treatment is considered as being of moderate complexity. - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER! registered for member area and forum access, https://www.cms.gov/Medicare/Prevenrvices/MPS-QuickReferenceChart-1.html#TOBACCO. The CMS has created two G codes for billing for tobacco cessation counseling services to prevent tobacco use for asymptomatic patients. Advising the patient to make changes in their behavior. It may not display this or other websites correctly. 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. She knows what questions need answers and developed this resource to answer those questions. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). Each attempt may include a maximum of 4 intermediate or intensive sessions, with a total of up to 8 face-to-face sessions during a 12-month period for individuals who use tobacco regardless of whether there are signs or symptoms of tobacco-related disease. 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. Search for jobs related to Does cpt code 99406 need a modifier or hire on the world's largest freelancing marketplace with 21m+ jobs. The total session lasted 55 minutes with 43 minutes spent on the patients depressive symptoms and 12 minutes spent on tobacco cessation. 99406. moking and tobacco use cessation counseling visit; S ntermediate, greater than 3 minutes up to 10 minutesi. Two new C codes have been created for facilities paid under OPPS when billing for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010: Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file. April 21st, 2019 - Does anyone here have access to Revenue Code crosswalk tools like Uniform Billing Editor or Revenue Cycle Pro I need a help with 6 codes . Counseling is furnished by a qualified physician or other Medicare-recognized practitioner. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service. 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. 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. Copyright 2023, CodingIntel Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407). Please reach out and we would do the investigation and remove the article. G0436: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short Descriptor: Tobacco-use counsel 3-10 min, G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min. Does cpt code 20552 need a modifier jobs I want to Hire I want to Work. registered for member area and forum access, https://www.uhcprovider.com/content/UHCCP-Procedure-to-Modifier-Policy-R0119.pdf. Medicare also allows for the reporting an E/M visit (99201-99215) in addition to the tobacco-counseling, if modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the E/M [Phurrough]. Learn more about the benefits of Effective January 1, 2010, Medicaid will cover smoking cessation counseling during a medical visit to pregnant and postpartum women and children and adolescents ages 10 to 21. This analysis was to evaluate whether the existing evidence on counseling to prevent tobacco use is sufficient to extend national coverage for cessation counseling to those individuals who use tobacco (but do not have signs or symptoms of tobacco-related disease). 3>. The number of services for either code is one (1), regardless of the number of injections at any individual site, and regardless of the number of sites. The revenue codes and UB-04 codes are the IP of the American Hospital Association. The AT modifier must not be placed on the claim when maintenance therapy has been provided. In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. These phone call codes had a status indicator of non-covered, but are now covered . Does the policy you have support that? For more about Betsy visit www.betsynicoletti.com. F17.220: Nicotine dependence, chewing tobacco, uncomplicated All rights reserved. Note: Refer to the 835 Health Care Policy Identification Segment (loop 2110 Service Payment Information REF), if present. i Centers for Disease Control and Prevention. I so sorry it took me a minute to get back to this. In addition, two new, temporary C codes have been created for facilities paid under the Outpatient Prospective payment System (OPPS) when billing for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010. The total annual benefit is for 8 sessions in a 12 month period. So, it looks like you need to add modifier 25. While the practitioner and patient have flexibility to choose between intermediate or intensive cessation strategies for each attempt, it is very important to be aware that frequency limits are beneficiary-specific; therefore, prior to providing tobacco cessation counseling to a beneficiary, you should review a given beneficiarys previous service provision (i.e. The new G codes for use on claims with dates of service on or after January 1, 2011 are: Note also the following claims processing information from CR 7133: Claims submitted with the tobacco cessation counseling codes of G0436 and G0437, but which lack a required diagnosis code (305.1 or V15.82) will be denied with Claim Adjustment reason Code (CARC) 167 (This (these) diagnosis (es) is (are) not covered. (Use for pregnant women who smoke).o 649.04 Tobacco use disorder complicating pregnancy childbirth or the puerperium postpartum. Code 99406 is a column 2 code for 90471, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. C9801 Smoking and tobacco cessation counseling visit for the asymptomatic patient, intermediate, greater than 3 minutes, up to 10 minutes Short descriptor: Tobacco-use counsel 3-10 min, C9802 Smoking and tobacco cessation counseling visit for the asymptomatic patient, intensive, greater than 10 minutes. 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. #1 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 99214-25 99406 90715 (TDaP admin) 90471 (Imunization Admin) CPT code denies out as bundled like is but if I add a mod 25 to 99406 Code correct allows it to go through. So the combination 99396-25 and 99495 may well be acceptable. CCI Edit Rule: CPT Manual or CMS manual coding instructions These new CPT codes, which are included in the 2008 Medicare Physician Fee Database (MPFSDB), become effective for claims with dates of service January 1, 2008 and later. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total APA is dedicated to improving population health, along with advocating for financial incentives that support psychologists involvement in these efforts. APA Services is aware of commercial payers that will reimburse psychologists for reporting codes 99406 or 99407, as well as some Medicaid programs. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). For a better experience, please enable JavaScript in your browser before proceeding. In November 2009, based upon authority to cover additional preventive services for Medicare beneficiaries if certain statutory requirements are met, the CMS initiated a new national coverage analysis. RARC N362: The number of days or units of service exceeds our acceptable maximum. Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. RARC M64 Missing/incomplete/invalid other diagnosis CARC 167 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Ask all adults, including pregnant persons, about tobacco use, using methods such as: 5 As: Ask, Advise, Assess, Assist, Arrange follow-up, Vital Sign: Treat smoking status as a vital signwhich means assess regularly. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. The link to the policy for UHC they keep pointing me to is. And, a bonus sheet with typical time for those code sets. CPT code 96110 represents developmental screening, with interpretation and report. Use tobacco and exhibit symptoms consistent with a tobacco-related disease. CMS does not currently have specific training requirements, but may in the future. 2006;145:839844. Additional injectable immunization administrations are billed with CPT code 90472 . The patient uses tobacco, regardless of whether they have signs or symptoms of tobacco-related disease. CPT Manual defines modifier 59 as a "Distinct Procedural Service." The 59 modifier is considered the most misused modifier by coders. Medicare will allow payment for a medically necessary Evaluation and Management (E/M) service on the same date as tobacco cessation counseling, provided it is clinically appropriate. All Rights Reserved to AMA. Smoking and Death. Claims are accepted for G0436 and G0437 with revenue code 0510 when billed by IHS facilities. CPT Modifier 22 Increased Procedural Service Modifier 22 is used to describe an increased workload associated with a procedure. Beginning January 1, 2023 there are two Read More All content on CodingIntel is copyright protected. 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 Short descriptor: Tobacco-use counsel >10min During the same interim period of time between August 25, 2010, and December 31, 2010, carriers shall pay claims for these tobacco-cessation counseling sessions with unlisted code 99199. Offering additional resources, such as support groups for relapse prevention, or state tobacco cessation quitlines for support often including nicotine replacement therapy (NRT; patches, gum, lozenges, etc). CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December31, 2007. CodingIntel was founded by consultant and coding expert Betsy Nicoletti. Centers for Disease Control and Prevention P, Centers for Medicare and Medicaid Services:National Coverage Determination (NCD). F17.221: Nicotine dependence, chewing tobacco, in remission Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. Optum will align reimbursement with Medicare including up to 2 attempts of up to 4 sessions each for a total of up to 8 face-toface visits during a 12-month period for individuals who use tobacco regardless of whether there are signs or symptoms of tobacco-related disease. 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. I looked into the X modifiers however none of the descriptions seem to apply, unless I am misreading them. All the articles are getting from various resources. For pregnant persons, provide behavioral counseling for cessation: Effective behavioral counseling includes cognitive behavioral, motivational, and supportive therapies such as counseling, health education, feedback, financial incentives, and social support. JavaScript is disabled. (Use for children and adolescents ages 10 up to 21).o 649.03 Tobacco use disorder complicating pregnancy, childbirth or the puerperium antepartum. 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. These are in addition to the two CPT Codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic iindividuals. 3. Medicare Part B covers two levels of tobacco cessation counseling for beneficiaries: intermediate and intensive. Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. People with behavioral health conditions who smoke cigarettes are four times more likely to die prematurely than those who do not smoke. 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. Each attempt may include a maximum of four intermediate OR intensive sessions, with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco. This tool is intended to assist suppliers in determining potential modifiers that may be used in billing DMEPOS HCPCS codes. Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, Medicare revalidation process how often provide need to do FAQ, Step by step Guide Medicare participation program. The following HCPCS codes should be reported when billing for counseling to prevent tobacco use services: 99406 - Smoking and tobacco-use cessation . Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file. APA Services also recommends that checking each commercial payer policy, and the list of codes included in your contract with each payer, to determine coverage for this service. %%EOF Contact NCTracks Contact Center 99397 and additional screening codes 99406-99409 and 96160) when reported in conjunction with immunization administrative services (90460-99474) . Report the appropriate E&M code with modifier -25 along with the preventive medicine services code. Freelancer Thus, insertion of an intravenous catheter (e.g., CPT codes 36000, 36410) for intravenous infusion, injection or chemotherapy administration (e.g., CPT codes 96360-96368, 96374-96379, 96409-96417) shall not be reported separately. Medicare waives the co-payment/co-insurance and deductible for this service. Copyright American Medical Association. These visits must be provided by a qualified health care provider. Can someone please help me. with modifier 25 to indicate that the E/M service is a separately identifiable service from 99406 or 99407. Freelancer 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. Counseling involving only 1 session lasting less than 3 minutes is considered part of an E/M service and is not reimbursed separately. Modifier Lookup Tool. Claims without the AT modifier will be . CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. CPT Code: 99453 averages about $19.00 when billable. Addressing barriers to change and ways to avoid relapse. The main CPT Codes that are used for RPM are 99453, 99454, 99457, 99458. . Medicare will cover two (2) cessation attempts per year. 1/j,Q}"5iKW; The new G codes for use on claims with dates of service on or after January 1, 2011 are: G0436: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short Descriptor: Tobacco-use counsel 3-10 min; G0437: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min. When denying claims for counseling to prevent tobacco use services and smoking and tobaccouse cessation counseling services that exceed a combined total of 8 sessions within a 12-month period (G0436, G0437, 99406, 99407), contractors shall use the following messages: MSN 20.5: These services cannot be paid because your benefits are exhausted at this time. MSN Spanish Version: Estos servicios no pueden ser pagados porque sus beneficios se han agotado., CARC 119: Benefit maximum for this time period or occurrence has been reached.. 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. National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control. The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for dates of service on or after January 1, 2011. For more information, please visit the National Native Networks Keep it Sacred website. If you also report an E/M, then the 25 modifier would go on the E/M. Hi, I submitted CPT code 82948-QW but still denied. hT_HSQ:ui;IE,y+OaC)S70((I-!H,5`O!f=u])c}| >09h`q`b -'V-Q;zVU+8Z{?Bra|};2:k0;}Z ip`>UOtmGf3}7]VFK9 PZK}0,ZFrR1gOeE\]0s-s:5l.Aj[KnX'lO$]V#{dR_7mtVRjk\YJ 7bp.We($)6^BZ Key point to remember! Does CPT code 99496 need a modifier? Minimal counseling3> Modifier 59 is used to identify procedures/services that are . { The level of service reported is dependent upon the amount of time spent performing smoking and tobacco use cessation counseling services. Patients diagnosed with mental and behavioral health disorders have higher rates of smoking as well as increased morbidity. Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011. Health Effects of Cigarette Smoking Fast Facts and Fact Sheets. 99407 Smoking cessation counseling, greater than 10 minutes Only one procedure code per day may be billed. The definition of the 59 modifier per the CPT manual is as follows: Modifier 59: "Distinct Procedural Service" - Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. 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.

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