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<p class="MsoNormal">Hello, as a follow up to today's TPEP call, I'm sharing with you information on which health professionals can bill for tobacco cessation services for Oregon Health Plan members. Please refer to
<a href="http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_410/410_130.html">
<span style="color:windowtext">OAR 410-130-0190</span></a> "Tobacco Cessation" for more details. I will work on posting this to the cessation page of HPCDP connection.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thanks, Beth<o:p></o:p></p>
<p class="MsoNormal">-----------------------------------------------------<o:p></o:p></p>
<p class="MsoNormal">In Oregon, CPT codes 99406, 99407 (cessation counseling) are open to payment to the following providers:<o:p></o:p></p>
<p class="MsoNormal"> 34 – physician<o:p></o:p></p>
<p class="MsoNormal"> 38 – advanced comp health care (includes naturopathic physician)<o:p></o:p></p>
<p class="MsoNormal"> 42 – Advance Practice Nurse<o:p></o:p></p>
<p class="MsoNormal"> 46 – Physician Assistants<o:p></o:p></p>
<p class="MsoNormal"> 47 – Clinic<o:p></o:p></p>
<p class="MsoNormal">38 – advanced comp health care (includes naturopathic physician)<o:p></o:p></p>
<p class="MsoNormal">and 47 – Clinic are not covered by the federal guidelines.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">In Oregon, CPT codes G0436 and G0437(cessation counseling) are open to payment to the following services:<o:p></o:p></p>
<p class="MsoNormal"> 34 – physician<o:p></o:p></p>
<p class="MsoNormal"> 42 – Advance Practice Nurse<o:p></o:p></p>
<p class="MsoNormal"> 46 – Physician Assistants<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">December 28, 2012 Rulebook
<o:p></o:p></span></p>
<p class="Default"><b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">Oregon Administrative Rule 410-130-0190 Tobacco Cessation
</span></b><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext"><o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(1) Tobacco treatment interventions may include one or more of these services: basic, intensive, and telephone calls.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(2) Basic tobacco cessation treatment includes the following services:
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(a) Ask -- systematically identify all tobacco users -- usually done at each visit;
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(b) Advise -- strongly urge all tobacco users to quit using;
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(c) Assess – the tobacco user’s willingness to attempt to quit using tobacco within 30 days;
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(d) Assist -- with brief behavioral counseling, treatment materials and the recommendation/prescription of tobacco cessation therapy products (e.g., nicotine
patches, oral medications intended for tobacco cessation treatment and gum); <o:p>
</o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(e) Arrange -- follow-up support and/or referral to more intensive treatments, if needed.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(3) When providing basic treatment, include a brief discussion to address client concerns and provide the support, encouragement, and counseling needed to
assist with tobacco cessation efforts. These brief interventions, less than 6 minutes, generally are provided during a visit for other conditions, and additional billing is not appropriate.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(4) Intensive tobacco cessation treatment is on the Health Services Commission's Prioritized List of Health Services and is covered if a documented quit date
has been established. This treatment is limited to ten sessions every three months. Treatment is reserved for those clients who are not able to quit using tobacco with the basic intervention measures.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(5) Intensive tobacco cessation treatment includes the following services:
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(a) Multiple treatment encounters (up to ten in a 3 month period);
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(b) Behavioral and tobacco cessation therapy products (e.g., nicotine patches, oral medications intended for tobacco cessation treatment and gum);
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(c) Individual or group counseling, six minutes or greater.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(6) Telephone calls: the Division may reimburse a telephone call intended as a replacement for face-to-face contact with clients who are in intensive treatment
as it is considered a reasonable adjunct to, or replacement for, scheduled counseling sessions:
<o:p></o:p></span></p>
<p class="MsoNormal">(a) The call must last six to ten minutes and provides support and follow-up counseling;<b><o:p></o:p></b></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(b) The call must be conducted by the provider or other trained staff under the direction or supervision of the provider;
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(c) Enter proper documentation of the service in the client's chart.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(7) Diagnosis Code ICD-9-CM 305.1 (Tobacco Use Disorder):
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(a) Use as the principal diagnosis code when the client is enrolled in a tobacco cessation program or if the primary purpose of the visit is for tobacco cessation
services; <o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(b) Use as a secondary diagnosis code when the primary purpose of this visit is not for tobacco cessation or when the tobacco use is confirmed during the visit.
<o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">(8) Billing Information: Managed care plans may have tobacco cessation services and programs. This rule does not limit or prescribe services a Prepaid Health
Plan provides to clients receiving the Basic Health Care Package. <o:p></o:p></span></p>
<p class="Default"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:windowtext">Stat. Auth.: ORS 413.042
<o:p></o:p></span></p>
<p class="MsoNormal">Stats. Implemented: ORS 414.025, 414.065<o:p></o:p></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Beth Sanders, MPH<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Cessation Coordinator<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Center for Prevention and Health Promotion | Oregon Public Health Division<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">800 NE Oregon St., Suite 730 | Portland, Oregon 97232 | (971) 673-0563<o:p></o:p></span></p>
<p class="MsoNormal"><u><span style="color:#1F497D">elizabeth.c.sanders@state.or.us<o:p></o:p></span></u></p>
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