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National Government Services, Inc.
 Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter
MMR-2008 03AB, March 2008

MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)

Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare

MLN Matters Number: MM5878
Related Change Request (CR) #: 5878
Related CR Release Date: February 1, 2008
Effective Date: January 1, 2008
Related CR Transmittal #: R1433CP
Implementation Date: July 7, 2008

Provider Types Affected
Physicians and providers who bill Medicare contractors (fiscal intermediaries (FI), carriers, or Medicare Administrative contractors (A/BMAC)) for smoking and tobacco use cessation counseling 

Provider Action Needed

Impact to You
Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407). If you bill using the former HCPCS codes (G0375 and G0376) for services provided after December 31, 2007, your claims will not be paid.

What You Need to Know
CR 5878, from which this article is taken, announces that the 2008 Medicare Physician Fee Database (MPFSDB) includes two new CPT codes for smoking and tobacco use cessation counseling services; replacing the temporary HCPCS G codes (G0375 and G0376) currently in use for billing these services. These new codes (effective on and after January 1, 2008) are:

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

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

What You Need to Do
Make sure that your billing staffs are aware of these newly required CPT codes for smoking and tobacco use cessation counseling services.

Background
CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December 31, 2007.

They are being replaced by two new CPT codes (99406- Smoking and tobacco-use cessation counseling visit; intermediate, greater than three minutes up to ten minutes; and 99407 - Smoking and tobacco-use cessation counseling visit; intensive, greater than ten minutes). These new CPT codes, which are included in the 2008 Medicare Physician Fee Database (MPFSDB), become effective for claims with dates of service January 1, 2008 and later.

FIs, carriers, and A/B MACs will pay for counseling services billed with HCPCS codes G0375 and G0376 for dates of service performed on and after March 22, 2005 through December 31, 2007 and with CPT codes 99406 and 99407 for dates of service on or after January 1, 2008.

Additional Information
You can find CR 5878 at http://www.cms.hhs.gov/Transmittals/downloads/R1433CP.pdfExternal PDF on the Centers for Medicare & Medicaid Services (CMS) Web site. You will find the updated Medicare Claims Processing Manual, Chapter 32 (Billing Requirements for Special Services), Sections 12.1(HCPCS and Diagnosis Coding), 12.2 (Carrier Billing Requirements), and 12.3 (FI Billing Requirements) as an attachment to that CR.

If you have any questions, please contact your FI, carrier, or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zipZip File on the CMS Web site.

Disclaimer
 This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2007 American Medical Association.