If you have cardiac patients that smoke or use tobacco and you decide to provide cessation counseling services, you may be entitled to additional reimbursement from Medicare. Effective March 22, 2005, the Centers for Medicare and Medicaid Services (CMS) has determined that the evidence is adequate to conclude that smoking and tobacco use cessation counseling, based on the current PHS Guideline, is reasonable and necessary for certain individuals who use tobacco and have a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information. These individuals will be covered under Medicare Part B when certain conditions of coverage are met, subject to certain frequency and other limitations. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism is affected by tobacco use.

The Centers for Medicare & Medicaid Services will cover two new levels of counseling for smoking cessation (intermediate and intensive). Medicare instructs providers, as of July 5, 2005, to use the two new G codes created for billing smoking and tobacco-use cessation counseling services.

They are as follows:

• G0375 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. This code pays about $13.
• Short Descriptor: Smoke/Tobacco counseling 3-10
• G0376 - Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes. This code pays about $25.
• Short Descriptor: Smoke/Tobacco counseling greater than 10

Medicare will allow 8 visits annually in a 12-month period for the above services. 

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. 

Click here to review the complete transmittal from CMS.

If you have questions or comments regarding this issue you may contact Heart Rhythm Society at 202-464-3400 or email Allison Waxler at awaxler@hrsonline.org.