does cpt code 99406 need a modifier

The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. CPT Code 90792: Billing Guide with Reimbursement Rates [2023] Hi, I submitted CPT code 82948-QW but still denied. Because Intermediate sessions (code 99406) represent counseling the patient for 3-10 minutes, while intensive sessions (code 99407) describe counseling the patient for greater than 10 minutes. 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes -Avreage fee amount- $25 $30. 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. | Medical Billing and Coding Forum - AAPC If this is your first visit, be sure to check out the FAQ & read the forum rules. In reading some posts in the forum, it looks like several people have commented that they have received denials from Medicare for smoking cessation counseling and that it was likely due to the Dx codes, specifically the F17.20 - F17.299 codes. Smoking and Death. These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. CPT 99406/99407 advice | Medical Billing and Coding Forum - AAPC Do not report 99406 in conjunction with 99407. The CPT codes are listed below for billing for smoking cessation: 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 A modifier 25 may be appropriate to append to the primary E/M visit code. a CodingIntel membership, Last revised January 5, 2023 - Betsy Nicoletti Tags: screening and counseling for behavioral conditions. The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF563 KB]. Claims for these counseling services must be submitted with the appropriate diagnosis code. 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. Short descriptor: Tobacco-use counsel >10min Claims for smoking and tobacco use cessation counseling services G0436 and G0437 shall be submitted with diagnosis code V15.82, history of tobacco use, or 305.1, non-dependent tobacco use disorder. Each attempt may include a maximum of four intermediate or intensive sessions. Code 99406 is a column 2 code for 90471, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. One of these statutory requirements is that the service be categorized as a grade A (strongly recommends) or grade B (recommends) rating by the US Preventive Services Task Force (USPSTF).

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