CPT 99406, 99407 Coverage Extended to All Smokers

CMS announcement is triumph for physicians who haven’t collected in the past.

If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.

In the past, CMS only covered 99406-99407 (Smoking and tobacco use cessation counseling visit…) for a beneficiary with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them stop using tobacco.”

“For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”

The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. “The new benefit will cover two individual tobacco cessation counseling attempts per year,” CMS indicated in an Aug. 25 news release. “Each attempt may include up to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who uses tobacco.”

“We know that older adults and other Medicare beneficiaries can be successful in their struggles to stop using tobacco, as long as they have the right resources available to them,” said HHS’s Howard Koh, MD, MPH in an Aug. 25 statement. “Today’s decision will assure that beneficiaries can access that help from qualified physicians and other Medicare-recognized practitioners.”

To stay up to date on Medicare coverage issues, subscribe to Part B Insider, written by Torrey Kim, MA, CPC.

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