The Billing Corner

Confidential Services and Tracking Smokers

The Billing Corner: Confidential Services and Tracking Smokers

Confidential Services

This designates services that are confidential between the health care provider and the patient.  These confidential services are appropriate for billing IF your client is enrolled in Medicaid or a Medicaid Health Plan.  If your client has Commercial insurance – consider billing only for the non-confidential services that you provided.

The current Medicaid Health plans in the state are:

  • Blue Cross Complete of Michigan
  • Coventry Cares
  • HAP Midwest Health Plan
  • Harbor Health Plan
  • HealthPlus Partners
  • McLaren Health Plan
  • Meridian Health Plan
  • Molina Healthcare of Michigan
  • Priority Health Choice
  • Sparrow PHP
  • Total Health Care
  • United Healthcare Community Plan
  • Upper Peninsula Health Plan

Tracking Smokers for Quality Improvement Purposes

  1. Use ICD-9 Diagnoses code 305.1 (Tobacco use disorder) or 649.0x if you are working with a pregnant mom
  2. Use CPT Codes  99406/99407 for Counseling. 99406 is Intermediate type of counseling that is greater than 3 minutes but not more than 10 minutes.  99407 is Intensive counseling that is greater than 10 minutes. Current Michigan Medicaid fee schedule for 99406 pays $6.93 and 99407 pays $14.26.
  3. When billing commercial insurers, various E/M services (associated with acute or chronic care) may be coded.  When providing an E/M service, if greater than 50% of face-to-face time with patient is spent on counseling, time may be used as a basis for selection of level of service.
  4. As of January 1, 2014 all state Medicaid programs are required to support all FDA-approved smoking cessation medications WITHOUT requiring co-pays or other financial barriers.

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