Can a 9-minute phone appointment for smoking cessation counseling with a Medicare patient be billed using CPT (Current Procedural Terminology) code 99406 or 99407?

Billing for Smoking Cessation Counseling via Phone

This visit can be billed using CPT code 99406 for the 9-minute smoking cessation counseling session conducted via phone with the Medicare patient.

Medicare Coverage for Smoking Cessation Counseling

Medicare provides coverage for smoking cessation counseling regardless of whether it is delivered in person or via phone. The billing code depends on the duration of the counseling session:

• CPT code 99406: For intermediate counseling sessions lasting 3-10 minutes
• CPT code 99407: For intensive counseling sessions lasting more than 10 minutes 1

Rationale for Using CPT Code 99406

The pharmacist's 9-minute phone counseling session falls within the 3-10 minute range that qualifies for the intermediate counseling code 99406. Since the session did not exceed 10 minutes, it does not meet the criteria for the intensive counseling code 99407.

Medicare Coverage Parameters

Medicare covers up to 8 smoking cessation counseling sessions per 12-month period, which can be divided into two cessation attempts per year with up to four sessions per attempt 1. This coverage applies to both outpatient and hospitalized beneficiaries who are smokers.

Phone-Based Counseling Validity

The Centers for Medicare and Medicaid Services (CMS) explicitly recognizes various delivery methods for smoking cessation counseling, including phone-based counseling 1. This is supported by clinical guidelines that acknowledge phone counseling as an effective method for delivering smoking cessation support:

• The National Comprehensive Cancer Network guidelines specifically mention that counseling can be delivered "in-person and/or by phone" 2
• The American Heart Association/American College of Cardiology guidelines recognize telephone-based support as an effective behavioral intervention for smoking cessation 2

Documentation Requirements

For proper reimbursement, the pharmacist should document:

• Patient's current smoking status
• Previous quit attempts
• Assessment of readiness to change
• Specific counseling provided during the session
• Plan for follow-up 1

Common Billing Pitfalls to Avoid

1. Failing to track the number of sessions already provided within the 12-month period
2. Inadequate documentation of the smoking cessation counseling
3. Misunderstanding the coverage limits
4. Assuming phone-based counseling isn't covered 1

Clinical Effectiveness of Phone Counseling

Research supports the effectiveness of phone-based smoking cessation counseling. Studies have shown that telephone counseling can be as effective as in-person counseling for smoking cessation 3, 4. Phone counseling is particularly valuable for reaching patients who may have difficulty attending in-person sessions, such as elderly Medicare patients.

By correctly billing this 9-minute phone counseling session using CPT code 99406, the pharmacist ensures appropriate reimbursement while providing an evidence-based intervention that can help reduce smoking-related morbidity and mortality in this Medicare patient.