Medicare Compliance & Reimbursement

Question: Which Medicare beneficiaries qualify for tobacco cessation counseling?

Alabama Subscriber

Answer: The Center for Medicare & Medicaid Services (CMS) National Coverage Determination (NCD) on Counseling to Prevent Tobacco Use maintains specific guidelines for 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (… intensive, greater than 10 minutes). Medicare Part B can cover some tobacco cessation counseling for outpatient and hospitalized beneficiaries who use tobacco, even if they’re not showing signs or symptoms of disease related to smoking or other tobacco usage.

A provider may be reimbursed if these requirements are also met during the encounter:

• Patient is competent and alert at the time of the encounter
• A qualified physician or other Medicare-recognized practitioner provides counseling

According to the Medicare Claims Processing Manual, a beneficiary can receive eight sessions of tobacco counseling per 12-month period, and to receive another eight during a subsequent year; at least 11 months must pass since the first session covered by Medicare. Beneficiary counseling eligibility and verification can be completed through the CMS HIPAA Eligibility Transaction System (HETS).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC