Can you escalate to your provider rep, if you have one? When medically indicated, this additional E/M service is subject . Claims are accepted for G0436 and G0437 with revenue code 052X when billed on TOBs 71X or 77X. 2008, contractors shall pay claims when billed with CPT codes 99406 and 99407. If you find anything not as per policy. Combined behavioral counseling includes at least four or more behavioral counseling sessions with 90 to 300 minutes of total contact time. Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. 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. Use of modifiers other . Effective January 1, 2010, Medicaid will cover smoking cessation counseling during a medical visit to pregnant and postpartum women and children and adolescents ages 10 to 21. Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file. CPT Code: 99453 averages about $19.00 when billable. Each attempt may include a maximum of four (4) intermediate or (4) intensive sessions, with the total annual benefit covering up to eight sessions in a 12-month period. For a better experience, please enable JavaScript in your browser before proceeding. The level of service reported is dependent upon the amount of time spent performing smoking and tobacco use cessation counseling services. You are using an out of date browser. This is just a regular medical clinic that does office visits. CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December31, 2007. Medicare denied cgaston said: Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. BCBS prefix Why its important to read correctly. Medicare covers 2 cessation attempts per year. Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. 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, F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A, and Z87.891. When denying claims for counseling to prevent tobacco use services and smoking and tobaccouse cessation counseling services that exceed a combined total of 8 sessions within a 12-month period (G0436, G0437, 99406, 99407), contractors shall use the following messages: MSN 20.5: These services cannot be paid because your benefits are exhausted at this time. MSN Spanish Version: Estos servicios no pueden ser pagados porque sus beneficios se han agotado., CARC 119: Benefit maximum for this time period or occurrence has been reached.. CPT code 99453 is a one-time billing code that is used when a patient initially enrolls into a remote monitoring program at the recommendation of a physician or qualified healthcare professional (QHP). When documentation supports that a significant, separately identifiable problem-oriented evaluation and management (E/M) service is rendered, the appropriate code for the E/M service may be reported separately. Accueil Uncategorized does cpt code . Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. At the 43-minute mark, you spend five minutes assessing their smoking habits, understanding of health risks, and readiness to quit. The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 95800, 95801, 95806, G0398, G0399 and G0400. The CPT codes are listed below for billing for smoking cessation: 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 A modifier 25 may be appropriate to append to the primary E/M visit code. Only one of the codes should be reported on a claim form, depending on the amount of time that was spent performing the counseling visit. If this is your first visit, be sure to check out the. These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. All rights reserved. If this is your first visit, be sure to check out the. Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits. Medicare will cover two (2) cessation attempts per year. The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for those individuals who use tobacco but do not have signs or symptoms of tobacco-related disease. Does CPT code 98940 need a modifier? When a colonoscopy becomes diagnostic, anesthesia is reported using CPT 00811 with modifier PT. TDD/TTY: (202) 336-6123. All our content are education purpose only. Do not report 99406 for less than three minutes of service. Medicare covers counseling for tobacco cessation for outpatients and for inpatients. If the physician performs a comprehensive preventative medicine evaluation for new patients (99381-99387) or established patients (99391-99397), the smoking cessation counseling is included within the scope of the service. These are in addition to the two CPT Codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic iindividuals. Group 4 Codes ICD-10-CM Codes that DO NOT Support Medical Necessity Expand All | Collapse All Group 1 (1 Code) Group 1 Paragraph April 21st, 2019 - Does anyone here have access to Revenue Code crosswalk tools like Uniform Billing Editor or Revenue Cycle Pro I need a help with 6 codes . Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation. JavaScript is disabled. There two CPT Codes 99406 and 99407 that are used for tobacco cessation counseling for symptomatic individuals. Beginning January 1, 2023 there are two Read More All content on CodingIntel is copyright protected. The following HCPCS codes should be reported when billing for counseling to prevent tobacco use effective January 1, 2011: G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes Short descriptor: Tobacco-use counsel 3-10 min G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes Short descriptor: Tobacco-use counsel >10min. Assessed willingness to attempt to quit. The main CPT Codes that are used for RPM are 99453, 99454, 99457, 99458. . copayment is waived for CPT codes 99406 and 99407. Additionally, these individuals account for nearly half of all tobacco-related deaths each year.iv Smoking can exacerbate mental health symptoms and complicate treatment.v,vi,vii. 99397 and additional screening codes 99406-99409 and 96160) when reported in conjunction with immunization administrative services (90460-99474) . They are being replaced by two new CPT codes (99406 Smoking and tobaccouse 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). The definition of the 59 modifier per the CPT manual is as follows: Modifier 59: "Distinct Procedural Service" - Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. These new CPT codes, which are included in the 2008 Medicare Physician Fee Database (MPFSDB), become effective for claims with dates of service January 1, 2008 and later. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. 99214 should be used for patients whose appointments are 25 minutes and whose treatment is considered as being of moderate complexity. Update from Medicare Additional injectable immunization administrations are billed with CPT code 90472 . Please reach out and we would do the investigation and remove the article. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Copyright 2023, CodingIntel Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. or anyone else have this same issue? As the first session nears the 45 minute mark, the patient again shares that they often step outside for a smoke after arguments at home, and that it leaves them more depressed after the buzz wears off. You ask if they would be open to using some session time to explore their smoking and they agree. JavaScript is disabled. If you are a member and have already registered for member area and forum access, you can log in by clicking here. Health Effects of Cigarette Smoking Fast Facts and Fact Sheets. Tobacco cessation therapy services may be billed in conjunction with the appropriate evaluation and management office visit code when medically necessary. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). My provider wants to start billing for smoking cessation so I'm doing some research to be sure we bill correctly. Search for jobs related to Does cpt code 99406 need a modifier or hire on the world's largest freelancing marketplace with 21m+ jobs. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos. F17.291: Nicotine dependence, unspecified, in remission | Medical Billing and Coding Forum - AAPC If this is your first visit, be sure to check out the FAQ & read the forum rules. Vital Signs: Current Cigarette Smoking Among Adults Aged 18 Years With Mental IllnessUnited States, 20092011. CPT codes %PDF-1.6 % For a better experience, please enable JavaScript in your browser before proceeding. For a better experience, please enable JavaScript in your browser before proceeding. They will appear in the quarterly coding updates for October 2010, and the TOS code is 1. (Use for post-partum women who smoke). F17.220: Nicotine dependence, chewing tobacco, uncomplicated CPT Code 99457 allows for reimbursement for time spent by the billing physician, a qualified healthcare professional ("QHCP"), or clinical staff. And preventing illness or injury 99406 Smoking and tobacco use cessation counseling visit ; intermediate greater. 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. Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. Policy: Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling 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; and. Intensive counseling is 4 sessions of more than 10 minutes each. Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes, (Rev. The claim must have a diagnosis of pregnancy (ICD-9- CM Diagnosis Codes: 630-677, V22, V23, V28). Practitioners and clinics must use the appropriate ICD-9 diagnosis code:o 305.1 Tobacco use disorder. These are for physical therapy, occupational therapy or speech-language pathology plan of care. 99407. ntensive, greater than 10 minutesi. | G0438, Age and wellness visits | Eligibility for Welcome to Medicare, Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. It may not display this or other websites correctly. { 750 First St. NE, Washington, DC 20002-4242, Telephone: (800) 374-2723. Documenting in this manner will show that while the two services were performed during the same encounter, the tobacco cessation counseling was considered a distinct and separately identifiable service. The CMS will allow two individual tobacco cessation counseling attempts per year. The revenue codes and UB-04 codes are the IP of the American Hospital Association. The counseling during an E/M service must be either intermediate or intensive. Copyright American Medical Association. The diagnosis code should reflect the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. All Rights Reserved to AMA. RARC M64 Missing/incomplete/invalid other diagnosis CARC 167 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Z87.891: Personal history of nicotine dependence. It is normally used to indicate that two or more procedures were performed during the same visit to different sites on the body. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS code, such as HCPCS 99201 99215, to report an E/M service with modifier 25 to indicate that the E/M service is a separately identifiable service from G0375 or G0376. registered for member area and forum access, https://www.uhcprovider.com/content/UHCCP-Procedure-to-Modifier-Policy-R0119.pdf. Peach State Health Plan will provide reimbursement for tobacco cessation therapy services CPT 99406 and CPT 99407. which insurance is primary. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered cessation session was performed. NOTE: The above G codes will not be active in contractors systems until January 1, 2011. Does cpt code 20552 need a modifier jobs I want to Hire I want to Work. The link to the policy for UHC they keep pointing me to is. Centers for Disease Control and Prevention P, Centers for Medicare and Medicaid Services:National Coverage Determination (NCD). 0 All the articles are getting from various resources. In addition to the HCPCS code, these services must be billed with ICD-10 diagnosis code Z87.891 (personal history of tobacco use/personal history of nicotine dependence), ICD-9 diagnosis code V15.82. .As usual, we start from the cluster created in the quick start documentation:. Each attempt may include a maximum of four intermediate or intensive counseling sessions. The CPT codes are listed below for billing for smoking cessation: 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 A modifier 25 may be appropriate to append to the primary E/M visit code. Can someone please help me. Medicare also allows for the reporting an E/M visit (99201-99215) in addition to the tobacco-counseling, if modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the E/M [Phurrough]. The total session lasted 55 minutes with 43 minutes spent on the patients depressive symptoms and 12 minutes spent on tobacco cessation. If this is your first visit, be sure to check out the. Freelancer Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017. iii Center for Behavioral Health Statistics and Quality. Mental health provider CPT codes 99406 and 99407 disease, or if the code is not recognized by will. Offering additional resources, such as support groups for relapse prevention, or state tobacco cessation quitlines for support often including nicotine replacement therapy (NRT; patches, gum, lozenges, etc). For more information about the . Watch this webinar about all these changes. 2006;145:839844. Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. All the articles are getting from various resources. If you also report an E/M, then the 25 modifier would go on the E/M. Reimbursement for smoking cessation counseling (SCC) must meet the following criteria: Services must be provided face-to-face. ONLY available for Medicaid-eligible pregnant females, women up to 6 months postpartum, and children and adolescents ages 10-21 who smoke. (2022, September 9). #1 Good Morning fellow coders, I would like to know your thoughts on billing 99406 (Smoking Cessation counseling 3-10 Min) when billing as an example the following codes today 99214-25 99406 90715 (TDaP admin) 90471 (Imunization Admin) CPT code denies out as bundled like is but if I add a mod 25 to 99406 Code correct allows it to go through. The total annual benefit is for 8 sessions in a 12 month period. If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. HCPCS codes for tobacco cessation counseling for asymptomatic individuals are: G0436: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than three minutes, up to 10 minutes, G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes Minimal counseling (<3 -25="" a="" and="" appended="" applicable="" as="" be="" cessation="" code="" counseling="" cpt="" date.="" distinct="" e="" either="" hcpcs="" is="" minutes="" modifier="" not="" on="" or="" p="" reimbursable="" reporting="" same="" separate="" service.="" service="" should="" the="" to="" tobacco="" when=""> In 2020, CMS changed the rates for codes 99441-99443 to the rates for 99212-99214. Preventive Medicine Service plus 50% of the problem-oriented E/M service code when that code is appended with modifier 25. RARC N362: The number of days or units of service exceeds our acceptable maximum. Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. You must log in or register to reply here. So, it looks like you need to add modifier 25. Dont have a login? Patients diagnosed with mental and behavioral health disorders have higher rates of smoking as well as increased morbidity. ), and Group code PR if a signed ABN is on file. A Group Code of CO is assigned if no ABN is on file. Medicaid Services, as well as other payers. I misspoke with the Amerigroup. annual benefit covering up to 8 sessions per year Medicare Beneficiary Pays 99406 and 99407: * Deductible waived Effective January 1, 2016, use CPT code 81528 when billing for the Cologuard test (note that your MAC will accept HCPCS code G0464 for claims with dates of service on or before December 31, 2015). I'm not able to locate the Amerigroup policy; can you provide a link? this notation came from my coding software. The CMS has created two G codes for billing for tobacco cessation counseling services to prevent tobacco use for asymptomatic patients. We don't bill often for smoking cessation, but I've had good success from Medicare by billing 99406 to dx code Z71.6, with a mod -25 on the preceding E/M code I've never had to bill a 99407, but I imagine there's nothing different compared to a 99406 D DeBillingTater Networker Local Chapter Officer Messages 32 Best answers 0 Feb 20, 2019 #3 2017. ii Substance Abuse and Mental Health Services Administration. 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. However, these limits do not apply to Paramount members as they are allowed an unlimited number of visits. For more information, please visit the National Native Networks Keep it Sacred website. Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Are you a coder, biller, administrator, These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes . Coding Information. re: Medicare denying CPT 82948. Provider Access to Smoking and Tobacco-Use Cessation Counseling Services Eligibility Data. DENIAL CODE Learn more about the benefits of Contractors shall only pay for 8 Smoking and Tobacco-Use Cessation Counseling sessions in a 12-month period. Modifier Lookup Tool. They are all part of HCPS, the Healthcare Common Procedure Coding System. ]~N 4(d9K{( The patient must be competent and alert at the time that counseling is provided. Counseling is furnished by a qualified physician or other Medicare-recognized practitioner. Please reach out and we would do the investigation and remove the article. NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed. Is it a standalone code or does it need to be used in conjunction with a problem-focused e/m or a preventive medicine visit? Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total 3. b. It may not display this or other websites correctly. You are using an out of date browser. This is a question our experts keep getting from time to time. Smoking and Death. The total annual benefit is for 8 sessions in a 12 month period. Now, we have got the complete detailed explanation and answer for everyone, who is interested! Some procedures do not need further clarification with a modifier. ACR Appropriateness Criteria Breast Imaging Resources Method of Detection (MOD) Clinical Decision Support Advanced Practice Providers Resources CDS FAQ Endorsements & Collaborations Contrast Manual Contrast Shortage Information Image-Guided Core Privileging Incidental Findings Interventional Radiology Resources Lung Cancer Screening Resources For a better experience, please enable JavaScript in your browser before proceeding. Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding (Rev. Reply. medicine service codes. It appears as if they can be stand alone codes. F17.201: Nicotine dependence, unspecified, in remission Two new C codes have been created for facilities paid under OPPS when billing for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010: Morbidity and Mortality Weekly Report 2013;62(05):81-7. vii NIH State-of-the-Science Panel. kotor things to do before leaving taris; can you wash bissell crosswave brush in the washing machine; lg dishwasher keeps counting down from 4. jessica hunsden carey; pasco county deaths 2022; mobile homes for rent in austin, tx by owner; rcmp ppc qualification; does cpt code 99495 need a modifier. NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed. - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER! CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. registered for member area and forum access, https://www.cms.gov/Medicare/Prevenrvices/MPS-QuickReferenceChart-1.html#TOBACCO. - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER! In addition, two new, temporary C codes have been created for facilities paid under the Outpatient Prospective payment System (OPPS) when billing for counseling to prevent tobacco use and tobacco-related disease services during the interim period of August 25, 2010, through December 31, 2010. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. Codes. November 28, 2017 at 5:35 pm. 99406, 99407 None SA, SB, GC, U1, U7, U9, 24, 25, 57, 99 . CPT is a registered trademark of the American Medical Association. I would add the modifier -GT to ALL services that were provided via telemedicine. Designed by Elegant Themes | Powered by WordPress. All Rights Reserved to AMA. When denying claims for counseling to prevent tobacco use services and smoking and tobaccouse cessation counseling services that exceed a combined total of 8 sessions within a 12-month period (G0436, G0437, 99406, 99407), contractors shall use the following messages: MSN 20.5: These services cannot be paid because your benefits are exhausted at this time., MSN Spanish Version: Estos servicios no pueden ser pagados porque sus beneficios se han agotado., CARC 119: Benefit maximum for this time period or occurrence has been reached., RARC N362: The number of days or units of service exceeds our acceptable maximum.. 7133-04.4.2 CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period. Claims are accepted for G0436 and G0437 with revenue code 0510 when billed by IHS facilities. Assessing the patients readiness for change. The new G codes for use on claims with dates of service on or after January 1, 2011 are: G0436: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short Descriptor: Tobacco-use counsel 3-10 min; G0437: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min. 99408 - CPT Code in category: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Addressing barriers to change and ways to avoid relapse. If you find anything not as per policy. No other tobacco cessation codes are eligible for waiver of coinsurance/deductible at this time. CMS does not currently have specific training requirements, but may in the future. APA is dedicated to improving population health, along with advocating for financial incentives that support psychologists involvement in these efforts. January 15, 2023 September 21, 2022 by Alexander Johnson. I looked into the X modifiers however none of the descriptions seem to apply, unless I am misreading them. F17.211: Nicotine dependence, cigarettes, in remission Each attempt may include a maximum of four intermediate or intensive counseling sessions. 2006;145:839844, viii NIH State-of-the-Science Panel. Providers may access coverage period remaining smoking and tobacco-use cessation counseling sessions and a next eligible date, when there are no remaining sessions, through the 270/271 eligibility inquiry and response transaction. Modifier -25 on 99406? As the first session hits the 54-minute mark, the patient offhandedly mentions they really need a smoke. You ask if theyd be open to discussing their smoking in session, and they seem hesitant but agree. NOTE: This decision does not modify existing coverage for minimal cessation counseling (defined as 3 minutes or less in duration) which is already considered to be covered as part of each Evaluation and Management (E/M) visit and is not separately billable. ), RARC N362 (The number of days or units of service exceeds our acceptable maximum. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. codes 99202-99215 reported with modifier -25 on the E/M service. These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). Medicare Part B already covers cessation counseling for individuals who: 1. number of counseling attempts the patient has received from other providers) within the preceding 12-month period to ensure claims are not denied due to exceeding the individual patient frequency limit.