Counseling to Prevent Tobacco Use HCPCS and Diagnosis Coding

12.1 - Counseling to Prevent Tobacco Use HCPCS and Diagnosis Coding (Rev. 13549; Issued: 12-18-25; Effective: 01-20-26; Implementation: 01-20-26) The following HCPCS codes should be reported when billing for counseling to prevent tobacco use services: 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 Note the above codes were effective for dates of service on or after January 1, 2008, and specifically effective for counseling to prevent tobacco use claims on or after October 1, 2016. Contractors shall allow payment for a medically necessary E/M service on the same day as the counseling to prevent tobacco use, when it is clinically appropriate. 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 99406 or 99407. Contractors shall only pay for 8 counseling to prevent tobacco use sessions in a 12-month period. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. To start the count for the second or subsequent 12-month period, begin with the month after the month in which the first Medicare covered counseling session was performed and count until 11 full months have elapsed. Claims for counseling to prevent tobacco use services shall be submitted with an appropriate diagnosis code. 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. Claims for counseling to prevent tobacco use services shall be submitted with an applicable diagnosis code: ICD-9-CM (prior to October 1, 2015) V15.82, personal history of tobacco use, or 305.1, non-dependent tobacco use disorder 989.84, toxic effect of tobacco ICD-10-CM (effective October 1, 2015) F17.210, nicotine dependence, cigarettes, uncomplicated, F17.211, nicotine dependence, cigarettes, in remission, F17.213 Nicotine dependence, cigarettes, with withdrawal F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders F17.220, nicotine dependence, chewing tobacco, uncomplicated, F17.221, nicotine dependence, chewing tobacco, in remission, F17.223 Nicotine dependence, chewing tobacco, with withdrawal F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders F17.290, nicotine dependence, other tobacco product, uncomplicated, F17.291, nicotine dependence, other tobacco product, in remission, or F17.293 Nicotine dependence, other tobacco product, with withdrawal F17.298 Nicotine dependence, other tobacco product, with other nicotine F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders Z87.891, personal history of nicotine dependence, unspecified, uncomplicated. T65.211A, Toxic effect of chewing tobacco, accidental (unintentional), initial encounter T65.212A, Toxic effect of chewing tobacco, intentional self-harm, initial encounter T65.213A, Toxic effect of chewing tobacco, assault, initial encounter T65.214A, Toxic effect of chewing tobacco, undetermined, initial encounter T65.221A, Toxic effect of tobacco cigarettes, accidental (unintentional), initial encounter T65.222A, Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter T65.223A, Toxic effect of tobacco cigarettes, assault, initial encounter T65.224A, Toxic effect of tobacco cigarettes, undetermined, initial encounter T65.291A, Toxic effect of other tobacco and nicotine, accidental (unintentional), initial encounter T65.292A, Toxic effect of other tobacco and nicotine, intentional self-harm, initial encounter T65.293A, Toxic effect of other tobacco and nicotine, assault, initial encounter T65.294A, Toxic effect of other tobacco and nicotine, undetermined, initial encounter Z72.0, Tobacco use effective October 1, 2024