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

Use ICD-9 Diagnoses code 305.1 (Tobacco use disorder) or 649.0x if you are working with a pregnant mom
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.
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.
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.