Reimbursement for Tobacco Interventions

 

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Introduction
Reimbursement

Reimbursement for tobacco interventions is in a state of change and moving toward more reimbursement for more services in more states. This section will describe procedures and provide resources for current mechanisms of reimbursement as well as describe changes in the near future.

This is a good time for providers to start building a practice in tobacco cessation treatment as the number of patients eligible for insurance reimbursement for these services is increasing.

To bill for tobacco cessation treatment you must use a procedural code and a diagnosis code. The insurance codes to use for reimbursement do vary a little by type of insurance. Here is an example of a commonly used set of procedural and billing codes:

  • Procedural code 99406 for brief counseling of 3 to 10 minutes
  • Diagnosis code - 305.1 Tobacco dependence

Some other variations include whether or not prior authorization is required, which type of health professional can provide the service, which medications can be prescribed, and how much counseling is covered, etc.

This section is divided up by private insurance, Medicare, and Medicaid. A number of other related topics are also covered, such as how to document tobacco cessation treatments in the medical record.