CMS Updates Guidance on Medicare Tobacco Cessation Billing

CMS has released updated guidance on the requirement that RHCs report the HCPCS code for each service furnished, along with the revenue code, on Medicare claims for services provided on or after April 1, 2016.

Coinsurance and deductible are waived for certain approved preventive health services (see Table 1 below). When a preventive health service is the primary service for the visit, RHCs should report modifier CG on the revenue code 052x service line with the preventive health service. Medicare will pay 100% of the all-inclusive rate for the preventive health service.

In early August, CMS revised the guidance to reflect that HCPCS codes G0436 and G0437, which were on the list of approved preventative services with coinsurance and deductible waived, will be discontinued effective October 1, 2016. CPT codes 99406 and 99407 are the remaining codes for tobacco cessation counseling. The beneficiary copayment is waived for both of these CPT codes.

For more information, you can read the full Medicare Learning Network Matters article here.