You've now got more flexibility to bill Medicare for trying to get smokers to quit via counseling sessions. HHS has expanded Medicare coverage for tobacco cessation counseling (billed via codes 99406 and 99407, which pay $13.64 and $26.18 respectively). The old policy restricted Medicare coverage for counseling to patients who'd been diagnosed with a tobacco-related disease or showed symptoms of such disease. The new policy opens counseling up to any Medicare beneficiary who happens to smoke.
"For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," HHS Secretary Kathleen Sebelius said in a prepared statement. "Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."
Under the new policy, tobacco cessation counseling for an individual patient may be attempted twice a year. Each attempt will include up to four covered sessions, for a total of eight covered sessions annually for a tobacco-using Medicare patient.
Nearly 10% of smokers -- 4.5 million out of 46 million -- are Medicare beneficiaries ages 65 and up, according to data from the Centers for Disease Control and Prevention (CDC). Another 1 million are younger than 65 but still covered by Medicare due to a disability.
Prevention and cost-savings are the rationale behind the new policy, CMS Administrator Donald Berwick, MD, said in a statement. Tobacco cessation immediately reduces the risk of death from coronary heart disease, chronic obstructive lung disease (COPD) and of course, lung and other types of cancer, he said.