Does the 25 modifier go on 99406?

Can you add modifier 25 to 99406?

Modifier 25 should be used on the claim when billing an E/M service along with the 99406 or 99407.

What is the Medicare policy for 99406?

Medicare Part B covers two levels of tobacco cessation counseling for beneficiaries: intermediate and intensive. Intermediate sessions (code 99406) represent counseling the patient for 3–10 minutes, while intensive sessions (code 99407) describe counseling the patient for greater than 10 minutes.

What DX covers 99406?

What is the modifier 25 for injections?

Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.

What is the 59 modifier used for?

Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.

What is the time requirement for 99406?

This measure defines tobacco cessation counseling as lasting 3 minutes or less. Services typically provided under CPT codes 99406 and 99407 satisfy the requirement of tobacco cessation intervention, as these services provide tobacco cessation counseling for 3-10 minutes.

Does Medicaid pay for 99406?

Additional services or supports are available through Medicaid & CHIP. Medicaid provides tobacco cessation counseling (procedure code 99406 & 99407) in individual and group settings to members 10 years and older with a diagnosis of nicotine dependence.

Can you bill 99406 with 99396?

Since those codes were added in 2008, the language in CPT failed to indicate that the new behavior change codes could be billed separately. So how many people know that, at least as far as the AMA is concerned, you can bill a 99396 and a 99406 (smoking cessation code) at the same session?

When to use modifier 25 and 59?

Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”

How are modifiers shown in CPT?

The most common CPT modifiers are nominated by letters or numbers. For example, the modifier -22 indicates increased services, while -52 means reduced fees. Other modifiers include -59 for distinct procedural service, -95 for telehealth, and -96 -97 for habilitative and rehabilitative services, respectively.

What is the modifier 24 and 25?

Modifier 24 refers to the evaluation and management services provided to the patient on the day of a surgical procedure unrelated to the procedure itself. Modifier 25 identifies the evaluation and management services as unique services provided on the same day by the same medical professional.

Where does modifier 25 go?

Appending the CPT modifier 25 to an E/M service code on a claim indicates the code is a significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service, the AMA issue brief (PDF) explains.

What modifiers are used for injections?

The use of the JA and JB modifiers is required for drugs which have 1 HCPCS Level II (J or Q) code but multiple routes of administration. Drugs that fall under this category must be billed with JA Modifier for the intravenous infusion of the drug or billed with JB Modifier for subcutaneous injection of the drug.

What are the CMS guidelines for using modifier 25?

Use modifier 25 (same-day significant, separately identifiable E/M service) on the claim when you report critical care services unrelated to the service or procedure that you perform on the same day. You must also document the medical record with the relevant criteria for the respective E/M service you're reporting.

Does Medicare pay 99406?

Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.

What is the CPT code for smoking cessation consultation?

For non-Medicare patients, if the consultation is done after the patient is admitted to the hospital, consultation services may be reported with the inpatient consultation codes (99251– 99255). Consultation services in observation status are reported with the outpatient consultation codes (99241–99245).

Does 99406 include vaping?

Answer: Yes, you may report smoking cessation counseling codes, such as 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (… intensive, greater than 10 minutes), for counseling related to vaping cessation.

What documentation is needed for 99406?

Documentation Requirements

Elements of documentation for CPT codes 99406-99407 may include, but are not limited to: • Type or method of tobacco use (cigarettes, pipe, chewing tobacco, etc.) Impact (personal, family, friends, health, social, financial, etc.)

How many times can you bill 99406?

Smoking Cessation Counseling Codes 99406 and 99407

Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year. A modifier 25 may be appropriate to append to the primary E/M visit code.

What is modifier 59 in medical billing?

Definitions. Modifier 59 describes a distinct procedural service, and is used to identify procedures and services that are not normally reported together.