Medicare - Tobacco Counseling Payments & Getting Paid

[Guest guest]

Anyone getting paid for this?http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdfI'm not quite sure I understand the difference between the G-codes and 9-codes -- G-codes mention " NON-dependent " tobacco use.

But as an add-on code - it is probably easy enough to throw into a regular visit.At least I would guess you can throw the code into a 99213 for a bronchitis ( or is that a symptomatic smoker? - maybe it's good for a rash visit) - also spend 3-minutes counseling for tobacco cessation.

$13 on top of a ~$60 Level 3 visit is a significant bump in pay for that visit -- with not much more effort - you are likely to counsel the patient anyway.I guess the difference in coding is symptomatic patients (COPD) get 9-code and asymptomatic (there for a rash, but also a smoker w/o other smoking related disease) get the G-codes. Is that right?

• G0436:  Long Descriptor:  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; 

• G0437: Long Descriptor:  Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min

99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals

99406 - Behav chng smoking 3-10 min

$13.49

99407 - Behav chng smoking > 10 min

$26.23

G0436 -Tobacco-use counsel 3-10 min

$13.83

G0437 - Tobacco-use counsel>10min

$27.92

HCPCS CODE

MODIFIER

PROC STAT

CARRIER

LOCALITY

NON-FACILITY

PRICE

FACILITY PRICE

NON-FACILITY LIMITING CHARGE

FACILITY LIMITING CHARGE

CONV FACT

99406

 

A

0410201

$13.49

$11.80

$14.74

$12.89

33.9764

99407

 

A

0410201

$26.23

$24.53

$28.65

$26.80

33.9764

G0436

 

A

0410201

$13.83

$11.80

$15.11

$12.89

33.9764

G0437

 

A

0410201

$27.92

$25.89

$30.50

$28.28

33.9764

Locke, MD

1 of 1 File(s)

MM7133.pdf

[Guest guest]

I got paid  today... bc I think..got 9 code

 

G codes are medicare specific.  9 codes are for private payers.  My understanding is that need to have Dx code that is affected by smoking (asthma, bronchitis, HTN, DM, etc) along with 305.1to get paid.  There are specifics on how many times a years they can get paid but it was pretty generous (4-6 maybe), not in office today, so can't pull it up right now.

[Attachment(s) from Locke included below]

Anyone getting paid for this?http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf

I'm not quite sure I understand the difference between the G-codes and 9-codes -- G-codes mention " NON-dependent " tobacco use.

But as an add-on code - it is probably easy enough to throw into a regular visit.At least I would guess you can throw the code into a 99213 for a bronchitis ( or is that a symptomatic smoker? - maybe it's good for a rash visit) - also spend 3-minutes counseling for tobacco cessation.

$13 on top of a ~$60 Level 3 visit is a significant bump in pay for that visit -- with not much more effort - you are likely to counsel the patient anyway.I guess the difference in coding is symptomatic patients (COPD) get 9-code and asymptomatic (there for a rash, but also a smoker w/o other smoking related disease) get the G-codes. Is that right?

• G0436:  Long Descriptor:  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; 

• G0437: Long Descriptor:  Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min

99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals

99406 - Behav chng smoking 3-10 min

$13.49

99407 - Behav chng smoking > 10 min

$26.23

G0436 -Tobacco-use counsel 3-10 min

$13.83

G0437 - Tobacco-use counsel>10min

$27.92

HCPCS CODE

MODIFIER

PROC STAT

CARRIER

LOCALITY

NON-FACILITY

PRICE

FACILITY PRICE

NON-FACILITY LIMITING CHARGE

FACILITY LIMITING CHARGE

CONV FACT

99406

 

A

0410201

$13.49

$11.80

$14.74

$12.89

33.9764

99407

 

A

0410201

$26.23

$24.53

$28.65

$26.80

33.9764

G0436

 

A

0410201

$13.83

$11.80

$15.11

$12.89

33.9764

G0437

 

A

0410201

$27.92

$25.89

$30.50

$28.28

33.9764

Locke, MD

Attachment(s) from Locke

1 of 1 File(s)

MM7133.pdf

-- Sangeetha