Wiki Smoking Cessation - Medicare covers

[pglazener]

I know this has been asked before but....Where can I get guidelines on how to bill for smoking cessation? I know Medicare covers it and I think Medicaid does as well but am unable to find how to bill for it. Also, do you know if commercial plans cover it?

 

[Pam Warren]

http://www.cms.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

page 237.

Check CPT codes 99406 and 99407, as well as HCPCS codes G0436 and G0437. Those two sets of codes vary by time, and as to whether the patient has a condition related to tobacco abuse, or is asymptomatic.

Also query your payers...some still are not covering this.

 

[jackson7591]

Reference

http://chestjournal.chestpubs.org/content/121/3/932.full.pdf

This site addresses possible components of a smoking cessation counceling visit and plan development. Our providers have found it very useful for documentation elements.

 

[btadlock1]

I know this has been asked before but....Where can I get guidelines on how to bill for smoking cessation? I know Medicare covers it and I think Medicaid does as well but am unable to find how to bill for it. Also, do you know if commercial plans cover it?

Some commercial payors may cover it for everyone, but the majority will delegate that to the groups, especially for self-funded plans. So, you'll end up with some BCBS patients that have it, when others don't (for example). I'd recommend checking individual benefits prior to the visit, if possible. I believe that with those, we bill it, and if it denies as non-covered, we just adjust it off. It's not really that much of a payment, honestly.