The U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence recommends the combination of medication and counseling for every patient who uses tobacco.
Qualified Beneficiaries
Medicare covers counseling to treat tobacco use for outpatient and hospitalized beneficiaries:
- Who use tobacco (regardless of signs or symptoms of tobacco-related disease).
- Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.
Covered Medications (Medicare Part C & D)
Every drug plan is required by Medicare to cover at least one of these FDA-approved medications:
| * Bupropion SR 150 (generic or Zyban) | * Nicotine inhaler | * Nicotine nasal spray |
| * Nicotine patch (prescription) | * Varenicline (Chantix) |
Covered Counseling (Medicare Part A & B)
Clinicians can at least double quit rates by following the Clinical Practice Guideline recommendation to counsel patients to quit. Medicare covers two individual cessation attempts per 12-month period per patient. Each attempt may include a maximum of four intermediate (3-10 minutes) or intensive (more than 10 minutes) sessions with the total annual benefit covering up to eight sessions in a 12-month period. Telehealth Service for smoking cessation—including outpatient, inpatient, and emergency department—is covered. Providers eligible for reimbursement are physicians, physician assistants and nurse practitioners, clinical nurse specialists, qualified psychologists, and clinical social workers.
Billing for Outpatient and Hospitalized Patients
99406, smoking and tobacco cessation counseling, intermediate, 3-10 minutes
99407, smoking and tobacco cessation counseling, intensive, greater than 10 minutes.
(NCD 210.4 Smoking and Tobacco Use Cessation Counseling).
Contractors shall allow payment for a medically necessary Evaluation and Management service on the same day as the counseling to prevent tobacco use service when it is clinically appropriate. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS code, such as HCPCS 99201–99215, to report an Evaluation and Management service with “-25 modifier” to indicate that the Evaluation and Management service is a separately identifiable service from 99406 or 99407.
Limits
Group therapy, telephone and web-based counseling are NOT covered. However, the Wisconsin Tobacco Quit Line is free and is available 24/7 to assist all Wisconsin residents who want to quit:
- Call 800-QUIT-NOW (800-784-8669)
- Click here
For Further Information
