1.0 CPT
Procedure Codes
96152, 96153, 99406, 99407
2.0 BACKGROUND
The National Defense Authorization Act (NDAA)
for Fiscal Year (FY) 2009 (Public Law 110-417, Section 713) signed
into effect on October 14, 2008, authorized provision of smoking
cessation counseling under TRICARE.
4.0
Policy
Considerations
4.1 Smoking cessation counseling is covered for
all TRICARE beneficiaries who are not eligible for Medicare and
reside in one of the 50 United States (U.S.) or the District of
Columbia, and only when the smoking cessation counseling is delivered
in one of the 50 U.S. or the District of Columbia.
4.2 There is
no requirement for the beneficiary to be diagnosed with a smoking
related illness to receive smoking cessation counseling.
4.3 Smoking
cessation counseling must be rendered by a TRICARE-recognized and
TRICARE-authorized provider working within the scope of their licensure
or certification to be cost-shared. Please reference
32 CFR 199.6 for provider types recognized
and eligible for authorization under TRICARE.
4.4 Current
Procedural Terminology (CPT) procedure codes 96152 (health and behavior intervention,
each 15 minutes, face-to-face; individual), 96153 (health and behavior
intervention, each 15 minutes, face-to-face; group), 99406 (smoking
cessation counseling visit; intermediate, greater than three minutes
up to 10 minutes), and 99407 (smoking cessation counseling visit;
intensive, greater than 10 minutes) are the only procedures codes
covered under this policy.
5.0 Exclusions
5.1 Smoking
cessation counseling rendered by a provider type NOT recognized
under TRICARE or by a provider that is not TRICARE-authorized.
5.2 Smoking
cessation counseling rendered to a beneficiary who resides outside
one of the 50 U.S. or the District of Columbia or smoking cessation
counseling delivered outside one of the 50 U.S. or the District
of Columbia.
5.3 TRICARE beneficiaries who are also Medicare
eligible (dual-eligible beneficiaries) are excluded from coverage
under this policy.