Forum - Questions & Answers

Feb 16th, 2010 - kouellette

Smoking Cessation

Can a Respiratory therapist certified in smoking Cessation bill codes 99406 and 99407.
Thank you,

Feb 16th, 2010 - nmaguire   2,606 

99406

Codes (99406 and 99407) should be used to report services provided face-to-face
by a physician or other qualified health care professional. Private payer coverage may vary from Medicare coverage; therefore, you should check with the private payers in your area to determine if specific coverage requirements exist for these services.
Medicare provides coverage for patients who use tobacco and have "a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or patients who are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use." There must be face-to-face time with the physician (or qualified provider) in order to bill these codes. Most often billed with E/M code (modifier -25), same day. Document time. Law states "qualified provider" for billing to Medicare.
The definition of "qualified provider" is pretty broad and includes, among others, physicians, clinical social workers, psychologists, hospitals, and rural health clinics
http://www.cms.hhs.gov/Transmittals/downloads/R1433CP.pdf

Feb 17th, 2010 -

Thank you!



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