Medicare Compliance & Reimbursement

Caution: Medicare imposes frequency limit on 99406-99407. Question: Do I still need a plan and referral to support smoking cessation counseling? Answer: An action plan and referral are not part of CMS's national requirements for reporting smoking counseling cessation. The Medicare National Coverage Determinations Manual (Section 210.4) and Medicare Claims Processing Manual (Chapter 32, Section 12.6, "Post-Payment Review for Smoking and Tobacco-Use Cessation Counseling Services") do not require that covered counseling must include a plan for the patient to quit or a referral to a treatment center. Take note: Section 12.6 of Chapter 32 of the Medicare Claims Processing Manual states that "Providers must keep patient record information on file for each Medicare patient for whom a Smoking and Tobacco-Use Cessation Counseling claim is made. These medical records can be used in any post-payment reviews and must include standard information along with sufficient patient histories to allow determination that the [...]