(Medicare Claims Processing Manual)

Note: ACP services are payable in hospice (Types of Bill 081x or 082x) when not part of the AWV when the services are performed by attending physicians that are employed by, or under arrangement with, the hospice.   150 - Counseling to Prevent Tobacco Use  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  Effective September 30, 2016, HCPCS codes G0436 and G0437 are no longer valid. The services previously represented by G0436 and G0437 should be billed under existing CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater  than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater 10 minutes) respectively. See Chapter 32 section 12 for coverage and billing requirements for smoking cessation services.   Note: For claims effective 10/1/16. CPT Codes 99406 or 99407 used for processing NCD210.4.1   NOTE: Instructions in sections 150 thru 150.4 are no longer valid.  Effective for claims with dates of service on and after August 25, 2010, the Centers for Medicare & Medicaid Services (CMS) will cover counseling to prevent tobacco use services for outpatient and hospitalized Medicare beneficiaries:    Who use tobacco, regardless of whether they have signs or symptoms of tobacco-  related  disease;    Who are competent and alert at the time that counseling is provided;  and,   Whose counseling is furnished by a qualified physician or other Medicare -recognized  practitioner.   These individuals who do not have signs or symptoms of tobacco- related disease will be covered under Medicare Part B when the above conditions of coverage are met, subject to certain frequency and other limitations.   Conditions of Medicare Part A and Medicare Part B coverage for counseling to prevent tobacco use are located in the Medicare National Coverage Determinations (NCD) Manual, Publication 100- 3, chapter1, section 210.4.1.   NOTE: Effective 9/30/15, NCD210.4 has been deleted from Pub. 100- 03 NCD Manual.  See NCD210.4.1 for remaining NCD re: Counseling to Prevent Tobacco Use.   150.1 - Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)    Effective September 30, 2016, HCPCS codes G0436 and G0437 are no longer valid. The services previously represented by G0436 and G0437 should be billed under existing CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater  than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater 10 minutes) respectively. See Chapter 32 section 12 for coverage and billing requirements for smoking cessation services.   The CMS has created two new CPT codes for billing for tobacco cessation counseling services to prevent tobacco use for those individuals who use tobacco but do not have signs or symptoms of tobacco- related disease.   The two CPT codes 99406 or 99407 that currently are used for smoking and tobacco- use cessation counseling for symptomatic individuals.   NOTE: The above G codes will not be active in A/B MAC (A), (B), and (HHH) systems until January 1, 2011. Therefore, A/B MACs (A), (B), and (HHH) shall advise non-  outpatient perspective payment system (OPPS) providers to use unlisted code 99199 to bill for counseling to prevent tobacco use a nd tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010.   On January 3, 2011, A/B MAC (A), (B), and (HHH) systems will accept the new G codes for services performed on or after August 25, 2010.  Two new C codes have been created for facilities paid under OPPS when billing for counseling to prevent tobacco use and tobacco- related disease services during the interim period of August 25, 2010, through December 31, 2010:   C9801 -  Smoking and tobacco cessation counseling visit for the asymptomatic patient, intermediate, greater than 3 minutes, up to 10 minutes   Short descriptor: Tobacco- use counsel 3- 10 min   C9802 -  Smoking and tobacco cessation counseling visit for the asymptomatic patient, intensive, greater than 10 minutes   Short descriptor: Tobacco- use counsel >10min  Claims for smoking and tobacco use cessation counseling services 99406 or 99407  shall be submitted with the applicable diagnosis codes:   ICD- 10-CM      ICD-10 CM Code  Code Description  F17.210  Nicotine dependence, cigarettes, uncomplicated  F17.211  Nicotine dependence, cigarettes, in remission  F17.213  Nicotine dependence, cigarettes, with withdrawal  F17.218  Nicotine dependence, cigarettes, with other nicotine -induced disorders  F17.219  Nicotine dependence, cigarettes, with unspecified nicotine -induced disorders  F17.220  Nicotine dependence, chewing tobacco, uncomplicated  F17.221  Nicotine dependence, chewing tobacco, in remission  F17.223  Nicotine dependence, chewing tobacco, with withdrawal  F17.228  Nicotine dependence, chewing tobacco, with other nicotine -induced disorders  F17.229  Nicotine dependence, chewing tobacco, with unspecified nicotine -induced disorders  F17.290  Nicotine dependence, other tobacco product, uncomplicated  F17.291  Nicotine dependence, other tobacco product, in remission  F17.293  Nicotine dependence, other tobacco product, with withdrawal  F17.298  Nicotine dependence, other tobacco product, with other nicotine -induced disorders  F17.299  Nicotine dependence, other tobacco product, with unspecified nicotine -induced disorders  T65.211A  Toxic effect of chewing tobacco, accidental (unintentional), initial encounter  T65.212A  Toxic effect of chewing tobacco, intentional self -harm, initial encounter  T65.213A  Toxic effect of chewing tobacco, assault, initial encounter  T65.214A  Toxic effect of chewing tobacco, undetermined, initial encounter  T65.221A  Toxic effect of tobacco cigarettes, accidental (unintentional), initial encounter  T65.222A  Toxic effect of tobacco cigarettes, intentional self -harm, initial encounter  T65.223A  Toxic effect of tobacco cigarettes, assault, initial encounter  T65.224A  Toxic effect of tobacco cigarettes, undetermined, initial encounter  T65.291A  Toxic effect of other tobacco and nicotine, accidental (unintentional), initial encounter  T65.292A  Toxic effect of other tobacco and nicotine, intentional self -harm, initial encounter  T65.293A  Toxic effect of other tobacco and nicotine, assault, initial encounter  T65.294A  Toxic effect of other tobacco and nicotine, undetermined, initial encounter  Z87.891  Personal history of nicotine dependence    A/B MAC (A), (B), and (HHH) shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco -use cessation counseling service   when it is clinically appropriate. Physicians and qualified non- physician practitioners shall use an appropriate HCPCS code to report an E/M service with modifier - 25 to indicate that the E/M service is a separately identifiable service from 99406 or 99407.  150.2 - A/B MACs (B) Billing Requirements  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  A/B MACs (B) shall pay for counseling to prevent tobacco use services billed with code G0436 or G0437 for dates of service on or after January 1, 2011. A/B MACs (B) shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010 through December 31, 2010. The type of service (TOS) for each of the new codes is 1.  A/B MACs (B) pay for counseling services billed based on the Medicare Physician Fee Schedule (MPFS). Deductible and coinsurance apply for services performed on August 25, 2010, through December 31, 2010. For claims with dates of service on and after Januar y 1, 2011, coinsurance and deductible do not apply on G0436 and G0437.  Physicians or qualified non- physician practitioners shall bill the A/B MACs (B) for counseling to prevent tobacco use services on Form CMS -1500 or an approved electronic format.   NOTE: The above G codes will not be active in MACs systems until January 1, 2011. Therefore, MACs shall advise providers to use unlisted code 99199 to bill for counseling to prevent tobacco use services during the interim period of August 25, 2010, through Dece mber 31, 2010.   NOTE: Effective September 30, 2016, HCPCS codes G0436 and G0437 are no longer valid. The services previously represented by G0436 and G0437 should be billed under existing CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater 10 minutes) respectively.   150.2.1 - A/B MAC (A) and (HHH) Billing Requirements  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  The A/B MACs (A) and (HHH) shall pay for counseling to prevent tobacco use services with codes G0436 and G0437 for dates of service on or after January 1, 2011. A/B MACs (A) and (HHH) shall pay for counseling services billed with code 99199 for dates of service performed on or after August 25, 2010, through December 31, 2010. For facilities paid under OPPS, A/B MAC s (A) shall pay for counseling services billed with codes C9801 and C9802 for dates of service performed on or after August 25, 2010, through December 31, 2010.  Claims for counseling to prevent tobacco use services should be submitted on Form CMS -1450 or its electronic equivalent.   The applicable bill types are 12X, 13X, 22X, 23X, 34X, 71X, 77X, and 85X. Payment for outpatient services is as  follows:   Type of Facility  Method of Payment  Rural Health Centers (RHCs) TOB 71X/Federally Qualified Health Centers (FQHCs)TOB  77X All-inclusive rate (AIR) for the encounter  Hospitals TOBs 12X and 13X  OPPS for hospitals subject to OPPS MPFS for  hospitals not subject to OPPS  Indian Health Services (IHS)  Hospitals TOB 13X  AIR for the encounter  Skilled Nursing Facilities  (SNFs) TOBs 22X and 23X  Medicare Physician Fee Schedule (MPFS)  Home Health Agencies  (HHAs) TOB 34X  MPFS  Critical Access Hospitals (CAHs) TOB 85X  Method I: Technical services are paid at 101% of reasonable cost. Method II: technical services are paid at 101% of reasonable cost, and Professional services are paid at 115% of the MPFS Data Base  IHS CAHs TOB 85X  Based on specific rate  Maryland Hospitals  Payment is based according to the Health Services Cost Review Commission (HSCRC). That is 94% of submitted charges subject to any unmet deductible, coinsurance, and non- covered charges policies.   Deductible and coinsurance apply for services performed on August 25, 2010, through December 31, 2010. For claims with dates of service on and after January 1, 2011, coinsurance and deductible do not apply for G0436 and G0437.  Effective September 30, 2016, HCPCS codes G0436 and G0437 are no longer valid. The services previously represented by G0436 and G0437 should be billed under existing CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater  than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater 10 minutes) respectively