CMS Pub. 100-04, ch. 18, § 150.2.1

The A/B MACs (A) and (HHH) shall pay for counseling to prevent tobacco use services

with codes G0436 and G0437 for dates of service on or after January 1, 2011. A/B MACs

(A) and (HHH) shall pay for counseling services billed with code 99199 for dates of service

performed on or after August 25, 2010, through December 31, 2010. For facilities paid

under OPPS, A/B MACs (A) shall pay for counseling services billed with codes C9801 and

C9802 for dates of service performed on or after August 25, 2010, through December 31,

2010.

Claims for counseling to prevent tobacco use services should be submitted on

Form CMS-1450 or its electronic equivalent.

The applicable bill types are 12X, 13X, 22X, 23X, 34X, 71X, 77X, and 85X.

Applicable revenue codes are as follows:

Provider Type Revenue Code

Rural Health Centers (RHCs) 052X

Federally Qualified Health Centers (FQHCs) 052x, 0519

Indian Health Services (IHS) 0510

Critical Access Hospitals (CAHs) Method II 096X, 097X, 098X

All Other Providers 0942

NOTE: When these services are provided by a clinical nurse specialist in the RHC/FQHC

setting, they are considered “incident to” and do not constitute a billable visit.

The applicable bill types are 12X, 13X, 22X, 23X, 34X, 71X, 77X, and 85X. Payment for

outpatient services is as follows:

Type of Facility Method of Payment

Rural Health Centers (RHCs)

Type of Bill (TOB) 71X

All-inclusive rate (AIR) for the encounter

Federally Qualified Health

Centers (FQHCs) TOB 77X

FQHC Prospective Payment System (PPS) for the

encounter

Hospitals TOBs 12X and 13X OPPS for hospitals subject to OPPS MPFS for hospitals

not subject to OPPS

Indian Health Services (IHS)

Hospitals TOB 13X

AIR for the encounter

Skilled Nursing Facilities

(SNFs) TOBs 22X and 23X

Medicare Physician Fee Schedule (MPFS)

Home Health Agencies (HHAs)

TOB 34X

MPFS

Critical Access Hospitals

(CAHs) TOB 85X

Method I: Technical services are paid at 101% of

reasonable cost. Method II: technical services are

paid at 101% of reasonable cost, and Professional

services are paid at 115% of the MPFS Data Base

IHS CAHs TOB 85X Based on specific rate

Maryland Hospitals Payment is based according to the Health Services

Cost Review Commission (HSCRC). That is 94% of

submitted charges subject to any unmet deductible,

coinsurance, and non-covered charges policies.

Deductible and coinsurance apply for services performed on August 25, 2010, through

December 31, 2010. For claims with dates of service on and after January 1, 2011,

coinsurance and deductible do not apply for G0436 and G0437.

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

NOTE: Section 4104 of ACA provided for a waiver of Medicare coinsurance and Part B

deductible for this service effective on or after 1/1/11. Copayment/coinsurance waived;

Deductible waived for HCPCS G0436 & G0437 through 9/30/16, for CPT codes 99406 &

99407 effective 10/1/16.