New Reimbursement Guidelines for Smoking Cessation

Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019.

In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code.

Approved Diagnosis Codes:

  • Nicotine dependence (F17.21-F17.299)
  • Personal history of nicotine dependence (Z87.891)
  • Initial encounter, toxic effect of tobacco and nicotine (T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A,  T65.224A, T65.291A, T65.292A, T65.293A, T65.294A)

Evaluation and management (E&M) services shall be considered for reimbursement on the same day as smoking and tobacco-use cessation counseling services (99406 or 99407) only when medically necessary, as indicated by appending Modifier 25 to the E&M service.


Horizon BCBSNJ shall limit smoking and tobacco-use cessation counseling (99406 or 99407) in any combination to eight times within a one-year period.

Reference: BCBSNJ

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