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TRICARE Policy Manual 6010.60-M, April 1, 2015
Other Services
Chapter 8
Section 19.1
Smoking Cessation Counseling
Issue Date:  November 13, 2009
Authority:  Public Law 110-417, Section 713
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-13, November 15, 2017
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.
3.0  Policy
Coverage may be extended for smoking cessation counseling in accordance with paragraph 4.0.
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.
6.0  Effective Dates
6.1  October 14, 2008.
6.2  Removal of quantitative limits on mental health care, October 3, 2016.
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