What modifier can be used with 99406?
25
MSCAN Tobacco Cessation Coverage To allow payment in this circumstance, providers should append a “25” modifier for 99406 or 99407 codes.
How often can you bill 99406?
The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year.
How many RVUS do I need for 99406?
This service is reimbursable from many payers and carries an RVU value of 0.35 for 99406 and 0.73 for 99407. However, some payers may put a limit on the number of times per year these codes can be used per patient.
Does Medicare pay for code 99406?
Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients about stopping tobacco use. Medicare waives the co-payment/co-insurance and deductible for this service.
What is the DX code for 99406?
Smoking and tobacco use cessation counseling visit
CPT codes for Smoking Cessation
| Code | Description | Total National facility RVUs |
|---|---|---|
| 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | 0.36 |
| 99407 | greater than 10 minutes | 26.71 |
How many times can you bill 99497?
Are there limits on how often I can bill CPT codes 99497 and 99498? Per CPT, there are no limits on the number of times ACP can be reported for a given beneficiary in a given time period. Likewise, the Centers for Medicare & Medicaid Services has not established any frequency limits.
What is modifier 55 used for?
Modifier 55 When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.
Does 99497 need a modifier?
Yes. Advance care planning is a preventive service only when provided in conjunction with an annual wellness visit and reported with modifier 33 attached to the advance care planning code (e.g., 99497-33).
Is 99406 covered by Medicare?
Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
Does Medicaid pay for 99406?
Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $27.93 . The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $14.32 . These are national reimbursement amounts, your local Medicare payments may vary.
What does medical code 99406 mean?
CPT ® codes for Smoking Cessation. There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient 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.
What is Medicare service code 96402?
The Current Procedural Terminology (CPT ®) code 96402 as maintained by American Medical Association, is a medical procedural code under the range – Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.