US · guidance
CMS Pub. 100-04, ch. 32, § 12.2
Counseling to Prevent Tobacco Use A/B MAC (B) Billing Requirements
A/B MACs (B) shall pay for counseling to prevent tobacco use services billed with codes 99406 and 99407 for dates
of service on or after October 1, 2016 A/B MACs (B) shall pay for counseling services billed with codes G0436 and
G0437 for dates of service on and after August 25, 2010, through September 30, 2016. The type of service (TOS) for
each of the new codes is 1.
A/B MACs (B) pay for these services billed based on the Medicare Physician Fee Schedule (MPFS). Deductible and
coinsurance are waived. Claims from physicians or other providers where assignment was not taken are subject to the
Medicare limiting charge, which means that charges to the beneficiary may be no more than 115% of the allowed
amount.
Physicians or qualified non-physician practitioners shall bill the A/B MAC (B) for counseling to prevent tobacco use
services using the ASC X12 837 professional claim format or the Form CMS-1500.
History
(Rev.3848, Issued: 08- 25-17, Effective: 09-26-17, Implementation: 09- 26-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
96147be682f436534ad74fd8fc39c9a83c470a7c71c898dfe5027ddd476174c5
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