CMS Pub. 100-04, ch. 18, § 150.1

Effective September 30, 2016, HCPCS codes G0436 and G0437 are no longer valid. The

services previously represented by G0436 and G0437 should be billed under existing CPT codes

99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes

up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive,

greater 10 minutes) respectively. See Chapter 32 section 12 for coverage and billing

requirements for smoking cessation services.

The CMS has created two new CPT 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.

The two CPT codes 99406 or 99407 that currently are used for smoking and tobacco-use

cessation counseling for symptomatic individuals.

NOTE: The above G codes will not be active in A/B MAC (A), (B), and (HHH) systems until

January 1, 2011. Therefore, A/B MACs (A), (B), and (HHH) shall advise non- outpatient

perspective payment system (OPPS) providers to use unlisted code 99199 to bill for counseling

to prevent tobacco use and tobacco-related disease services during the interim period of August

25, 2010, through December 31, 2010.

On January 3, 2011, A/B MAC (A), (B), and (HHH) systems will accept the new G codes for

services performed on or after August 25, 2010.

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:

C9801 - 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

C9802 - Smoking and tobacco cessation counseling visit for the asymptomatic patient,

intensive, greater than 10 minutes

Short descriptor: Tobacco-use counsel >10min

Claims for smoking and tobacco use cessation counseling services 99406 or 99407 shall be

submitted with the applicable diagnosis codes:

ICD-10

CM Code

Code Description

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

F17.293 Nicotine dependence, other tobacco product, with withdrawal

F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders

F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders

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

Z87.891 Personal history of nicotine dependence

A/B MAC (A), (B), and (HHH) 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. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS

code 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.