Effective September 30, 2016, HCPCS codes G0436 and G0437 are deleted. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits.

Who Is Covered

Outpatient and hospitalized Medicare beneficiaries for whom all of the following are true:

   • Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease

   • Competent and alert at the time of counseling

   • Counseling furnished by a qualified physician or other Medicare-recognized practitioner

HCPCS/CPT Codes

99406 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

99407 - Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes

ICD-10-CM Codes

F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A, and Z87.891

Frequency

Two cessation attempts per year. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions per year

Medicare Beneficiary Pays

99406 and 99407:

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

References