Tobacco cessation counseling
Clinical Practice Guideline
Tobacco cessation counseling billing
Priority Health will reimburse, fee for service, for tobacco cessation counseling codes. Reimbursement is available to primary care and specialty physicians.
- Document the time spent with the patient involving smoking cessation counseling.
- Document what was discussed during this counseling session (plans to decrease smoking and/or steps to quit smoking)
- Documentation must support the code being billed.
Examples of inadequate documentation
These examples lack a) the exact time and b) what was discussed.
- "Spent greater than 3 minutes counseling the patient on smoking."
- "Spent between 3 to 10 minutes counseling the patient on smoking."
- "Spent over 10 minutes counseling the patient on smoking."
The reimbursement rates for these codes are listed in our standard fee schedules for your contract. See schedules.
The CPT and HCPCS manuals define billing and coding requirements for tobacco counseling codes. Codes should be billed with the appropriate ICD10 code identifying tobacco use.
These codes can be billed by either the physician or a qualified health professional.
|99406||Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes||Payable as a preventive benefit; no member copayment or deductible|
|99407||Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes||Payable as a preventive benefit; no member copayment or deductible|
|4000F||Tobacco use cessation intervention, counseling (COPD, CAP, CAD, Asthma) (DM) (PV)||CMS CPTII report only code; no reimbursement|
|4001F||Tobacco use cessation intervention, pharmacologic therapy (COPD, CAD, CAP, PV, Asthma) (DM) (PV)||CMS CPTII report only code; no reimbursement|
|4004F||Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD)||CMS CPTII report only code; no reimbursement|
Priority Health recognizes the value of care management services that are integral to the patient-centered medical home, and reimburses for them. In addition to the codes on this page, see all expanded services codes including advance care planning, tobacco cessation and telephone and e-visit codes, in our Expanded services contracted billable codes listing.