Does Medicare pay for CPT 99406?

Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.

Does CPT 99406 need a modifier?

To allow payment in this circumstance, providers should append a “25” modifier for 99406 or 99407 codes. Magnolia Health (MH) indicates that 99406 and 99407 are reimbursed with no modifier or diagnosis limitations. The codes are payable on the physician side, but are not covered for outpatient facility claims.

What is the CPT code 99406?

smoking and tobacco cessation counseling visit
Counseling to the patient: Smoking and tobacco use counseling to the patient is reported using CPT code 99406 (smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or code 99407 (smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes).

Is 99406 an add on code?

Description of CPT code 99406 & 99407 CPT code 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling. Patient must be competent and alert at the time of counseling.

How many times can 99406 be billed?

The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year.

Can 99406 and 99407 be billed together?

99407 is not an add-on code, and the two codes are never reported together.

Does Medicare cover smoking cessation drugs?

You can get coverage for smoking cessation through original Medicare (parts A and B) — specifically Medicare Part B (medical insurance). You can also get coverage under a Medicare Advantage (Part C) plan. Medicare considers smoking cessation services to be preventive care.

Can nurses bill for smoking cessation?

In addition to the previously published list of providers of smoking cessation, local health departments can bill for these services when provided by an RN who has demonstrated competence in the tobacco cessation program in use in their agency.

How often can smoking cessation be billed?