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Reimbursement for Smoking Cessation 99406 and 99407

Letting reimbursable services go unbilled is something few family physicians can afford, yet we all do it. In some cases we decide that documenting and coding for a particular service is more trouble than it’s worth or we may simply misunderstand the billing requirements. But as our profit margins grow ever narrower, it’s especially foolish to leave money on the table. Determination and disciplined coding and documentation can make a noticeable difference in your revenue.

Check your opportunities!

You could be the one who yet have to catch the opportunity to get billing done for counselling for cessation on smoking and tobacco use. As coverage is provided  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.

Know the codes you work for!

When billing for more than three minutes of smoking and tobacco cessation counseling, you may use the following codes:

  • 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.

Payment can be done separately for tobacco cessation counseling of more than three minutes when diagnosis codes describe the patient’s condition or therapeutic agent affected by tobacco use.

How much it covers?

If your clinic is just beginning to provide these services to your patient population, it’s best to verify coverage criteria prior to claim submission. Many payers group tobacco use cessation counseling under the umbrella of anticipatory guidance and will not reimburse it separately. Knowledge of potential reimbursement errors keeps the denial rate low and provider-patient relationships strong.

Maximize reimbursement from all insurance payers!

  • Close the gap between peak cash potential and actual cash generated on claims by mitigating insurance denials and underpayments. We can provide intelligently workflow and analytics solution that helps ensure healthcare providers to  get ahead of denial management and achieve the highest reimbursement from all insurance payers.
  • You can be able to accelerate cash from insurance payers by quickly collecting on claims that might otherwise be denied.

Documentation may determine payment…

  • Proper documentation and verifying coverage criteria prior to claim submission can improve your chances for reimbursement.
  • Proper documentation for tobacco-use cessation counseling should include the total time spent face to face with the patient, and what was discussed clearly in details.

Our cutting-edge, proprietary technology combined with people domain expertise powers our outsourcing denial management solution to deliver both root-cause and actionable insights. We leverage sophisticated workflow and analytics that allow us to work accounts in groups by root causes with proven resolutions much faster than competing solutions.

It becomes essential in the  daily  struggle  to  ensure  the  financial  viability  of  our  practices,  as we  can’t  afford to  miss  these  payment opportunities. If you’re providing any of these services but not billing for them or if you’re not sure whether you’re getting paid or billing correctly for them, take action today. You’ll soon be glad you did it.

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