Medicare Compliance & Reimbursement

Question: We have a few patients with peripheral neuropathy and are trying to implement a strong smoking cessation program to educate them about how smoking affects this condition and the importance of quitting. Can we bill for this through telehealth, and can we bill for an evaluation and management (E/M) service? How often can we bill for this?

AAPC Forum Participant

Answer: First, your billing codes for smoking cessation coding are CPT^® 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).

Smoking and tobacco cessation counseling can be billed as a telehealth encounter. In fact, you can currently provide this education though audio-only means, but that may change once the public health emergency (PHE) special circumstances that allowed for some services to be delivered via audio-only technology during the pandemic expire.

Per Medicare guidelines, you can use 99406 or 99407 for two cessation attempts a year per patient, not per provider. If you receive denials, it’s most likely that another provider, such as the patient’s primary care provider (PCP), has already satisfied the frequency limitations for the patient. If you can bill for cessation attempts, you can have a maximum of four intermediate or intensive sessions per attempt, totaling eight sessions within 12 months. Private payer guidelines will differ, so be sure to check each carrier’s policies.

Tobacco cessation services can be billed with an E/M service. To do this, you will append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M. As the modifier descriptor directs, however, you must make sure the E/M service is significant and separately identifiable, meaning you must be able to document that the purpose of the E/M and the smoking and tobacco cessation service are completely different. Per CPT^® guidelines, “time spent providing [preventive E/M] services may not be used as a basis for the E/M code selection.”