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Counseling to Prevent Tobacco Use (for Asymptomatic Beneficiaries) (NCD 210.4.1)

The U.S. Surgeon General has reported that quitting smoking and stopping other forms of tobacco use lead to significant risk reduction for certain diseases and other health benefits, even in older adults who’ve smoked for years. Any person who uses tobacco can get counseling from a qualified doctor or other Medicare-recognized practitioner who can help them stop using tobacco.

Effective September 30, 2016, HCPCS codes G0436 and G0437 are deleted. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits.

HCPCS/CPT Codes


G0436 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes

G0437 – Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

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

ICD-10-CM (ICD-9-CM) Codes


Report one of the following codes:

F17.200, F17.201, F17.210, F17.211, F17.220 (305.1), 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 (V15.82).

F17.210, F17.211, F17.213, F17.218, F17.219, F17.220, F17.221, F17.223, F17.228, F17.229, F17.290, F17.291, F17.293, F17.298, F17.299, 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

Who Is Covered


Outpatient and hospitalized Medicare beneficiaries:

  • Who use tobacco, regardless of whether they exhibit signs or symptoms of tobaccorelated disease;
  • Who are competent and alert at the time of counseling; and
  • Who get counseling furnished by a qualified physician or other Medicarerecognized practitioner

Frequency


Two cessation attempts per year. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions per year

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

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