Part B Insider (Multispecialty) Coding Alert

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 CMSs 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, and 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 steps required in the coverage instructions were followed.

Nationally, Medicare has a frequency limitation for both 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (& intensive, greater than 10 minutes). Ensure the patient has not exceeded these benefits:

" Year 1: Two attempts in a 12-month period. Each attempt may include a maximum of four counseling sessions. A qualified physician or other Medicare recognized practitioner determines that a beneficiary meets the eligibility requirements and initiates treatment with a cessation counseling attempt. So a beneficiary may receive eight smoking and tobacco-use cessation counseling sessions in a 12-month period.

" Year 2: Another eight counseling sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered cessation counseling session was performed. For example, if the first of eight covered sessions was performed in May 2008, a second series of eight sessions may begin in May 2009.