How To Use HCPCS Code G9906

HCPCS code G9906 describes the provision of tobacco cessation intervention to a patient who has been identified as a tobacco user. This intervention can include counseling and/or pharmacotherapy and is typically provided during the measurement period or within the six months prior to the measurement period. In this article, we will explore the details of HCPCS code G9906, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9906?

HCPCS code G9906 is used to identify the provision of tobacco cessation intervention to a patient who has been identified as a tobacco user. This intervention can include counseling and/or pharmacotherapy. It is important to note that this code is specific to patients who have received tobacco cessation intervention during the measurement period or within the six months prior to the measurement period.

2. Official Description

The official description of HCPCS code G9906 is as follows: “Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy).” The short description for this code is “Pt recv tbco cess interv.”

3. Procedure

1. The provider identifies the patient as a tobacco user through patient history, self-reporting, or other means.
2. The provider assesses the patient’s readiness to quit tobacco use and determines the appropriate tobacco cessation intervention.
3. If counseling is chosen as the intervention, the provider engages in one-on-one or group counseling sessions with the patient, focusing on strategies to quit tobacco use and providing support throughout the cessation process.
4. If pharmacotherapy is chosen as the intervention, the provider prescribes or administers medications that aid in tobacco cessation, such as nicotine replacement therapy or other approved medications.
5. The provider documents the tobacco cessation intervention in the patient’s medical record, including the date, type of intervention, and any relevant details.

4. When to use HCPCS code G9906

HCPCS code G9906 should be used when a patient who has been identified as a tobacco user receives tobacco cessation intervention during the measurement period or within the six months prior to the measurement period. It is important to ensure that the patient meets the specific criteria outlined in the code description to accurately report the service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9906, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s identification as a tobacco user
• Documentation of the tobacco cessation intervention provided, including the type of intervention (counseling and/or pharmacotherapy), dates of service, and any relevant details
• Supporting documentation, such as progress notes, counseling session summaries, or medication prescriptions

Providers should follow the appropriate billing guidelines set forth by their respective payers to ensure accurate and timely reimbursement for the services rendered.

6. Historical Information and Code Maintenance

HCPCS code G9906 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of January 01, 2023, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. The code is classified as a medical care service and is not separately priced by Part B, as indicated by the pricing indicator code 00. The multiple pricing indicator code 9 indicates that the code is not applicable for separate pricing by Part B or that the value is not established.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G9906 may vary. Providers should consult with the respective payers to determine coverage and reimbursement policies. The pricing indicator code 00 indicates that the service is not separately priced by Part B and may be bundled or not covered. Providers should submit claims according to the guidelines set forth by the payer to ensure accurate reimbursement.

8. Examples

Here are five examples of scenarios in which HCPCS code G9906 should be billed:

1. A patient, identified as a tobacco user, receives individual counseling sessions focused on tobacco cessation during the measurement period.
2. A patient, identified as a tobacco user, receives group counseling sessions focused on tobacco cessation within the six months prior to the measurement period.
3. A patient, identified as a tobacco user, receives a prescription for nicotine replacement therapy to aid in tobacco cessation during the measurement period.
4. A patient, identified as a tobacco user, receives both individual counseling sessions and pharmacotherapy for tobacco cessation within the six months prior to the measurement period.
5. A patient, identified as a tobacco user, receives counseling sessions focused on tobacco cessation during the measurement period, and the provider documents the progress and outcomes of the intervention.