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.