does cpt code 99406 need a modifier

Has anyone had success with these codes? Expert Answers: Key point to remember! 2006;145:839844. In the . From reading the policy for Amerigroup - Policy to procedure - it almost sound like they want one of these modifiers, but their definitions are not for a regular mds doing E/M visits. 99406 and 99407 are the remaining codes for tobacco cessation counseling. How do you know if a CPT code needs a modifier? with modifier 25 to indicate that the E/M service is a separately identifiable service from 99406 or 99407. When tobacco cessation counseling services are performed at the same encounter as a psychotherapy session (codes 90832, 90834, 90837), both services should be listed on the billing form along with modifier -59 appended to the appropriate tobacco cessation code, which indicates that the tobacco cessation counseling service was distinctly and independently from the psychotherapy service. 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 Dec. 31, 2007 and with CPT codes 99406 and 99407 for dates of service on or after January 1, 2008. 99406- smoking cessation >3 min. Some procedures do not need further clarification with a modifier. CMS does not currently have specific training requirements, but may in the future. PDF Revenue Code Hcpcs Crosswalk - annualreport.psg.fr The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. These new codes (effective on and after January 1, 2008) are: 99406 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and 99407 - Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes. Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011. An initial treatment plan is agreed upon, and the first psychotherapy session is scheduled for later that week. Patient has WC and Medicare insurance? Prior to January 1, 2011, this service will be subject to the standard Medicare coinsurance and Part B deductible requirements. You are using an out of date browser. Its complete definition, defined by the American Medical Association Current Procedural Terminology 2012, is "a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. The counseling must be provided face-to-face with the patient. CR 7133 instructs that, effective for claims with dates of service on and after August 25, 2010, CMS will cover counseling to prevent tobacco use for outpatient and hospitalized Medicare beneficiaries: 1. Who use tobacco (regardless of whether they have signs or symptoms of tobacco-related disease), 2. Who are competent and alert at the time that counseling is provided, 3. 99406. moking and tobacco use cessation counseling visit; S ntermediate, greater than 3 minutes up to 10 minutesi. All Rights Reserved to AMA. Good Morning, I work for an urgent care the doctor always bill 99213 and 99406 together and Medicare always deny the claim stating they can't be billed together.

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