K039

PDF page 184 / A56

CONSULTATIONS AND VISITS
FAMILY PRACTICE & PRACTICE IN GENERAL (00)
   Initial discussion with patient re: smoking cessation
     Initial discussion with patient re: smoking cessation is the service rendered to a patient who
     currently smokes tobacco by the primary care physician most responsible for their patient’s
     ongoing care, in accordance with the guidelines and subject to the conditions below.
 E079 Initial discussion with patient, to eligible services ............. add         15.95
     Payment rules:
     1.E079 is only eligible for payment when rendered in conjunction with one of the following
        services: A001, A003, A004, A005, A006, A007, A008, A905, K005, K007, K013, K017,
        K130, K131, K132, K133, P003, P004, P005, P008, W001, W002, W003, W004, W008,
        W010, W102, W104, W107, W109 or W121.
     2.E079 is limited to a maximum of one service per patient per 12 month period.
     Medical record requirements:
     The medical record for this service must document that an initial smoking cessation discussion
     has taken place, by either completion of a flow sheet or other documentation consistent with
     the most current guidelines of the “Clinical Tobacco Intervention” (CTI) program, or the service
     is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.E079 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]
   Smoking cessation follow-up visit
     Smoking cessation follow-up visit is the service rendered by a primary care physician in the 12
     months following E079 that is dedicated to a discussion of tobacco smoking cessation, in
     accordance with the guidelines and subject to the conditions below.
 K039 Smoking cessation follow-up visit ........................................... 39.25
     Payment rules:
     1.K039 is only eligible for payment when E079 is payable to the same physician in the
       preceding 12 month period.
     2.K039 is limited to a maximum of two services in the 12 months following E079.
     Medical record requirements:
     The medical record for this service must document that a follow-up visit regarding smoking
     cessation has taken place, by either completion of a flow sheet or other documentation
     consistent with the most current guidelines of the “Clinical Tobacco Intervention” (CTI)
     program, or the service is not eligible for payment.
     [Commentary:
     1.Physicians may complete a flow sheet or alternatively document that an initial discussion
       consistent with the 5A's model of the CTI program has taken place.
     2.K039 is not eligible for payment for discussions related to cannabis smoking or discussions
       related to vaping, including vaping tobacco.]

PDF page 190 / A62

A680 Initial assessment – substance abuse ...................................      164.95
     Payment rules:
     1.A680 is limited to one per patient per physician or practice group except in circumstances
       where a 12 month period has elapsed since the most recent insured service rendered to the
       patient by the same physician.
     2.A680 is not eligible for payment for the assessment of substance abuse related to smoking
       cessation.
     [Commentary:
     1.For assessment services related to smoking cessation, see general listings, A957, K039 and
       E079 services, as applicable.
     2.For the purpose of A680, practice group is defined as those physicians who are part of the
       same billing group or are co-located and have shared access to the patient’s medical record.
     3.Unless otherwise specified in the Schedule, the calculation of time excludes (1) time devoted
       to any other service or procedure for which an amount is payable in addition to the
       assessment and (2) non-patient-facing time such as such as time spent reviewing charts,
       imaging, or documentation, etc.]

PDF page 192 / A64

Substance abuse - extended assessment
     A substance abuse - extended assessment is the service for providing care to patients
     receiving therapy for substance abuse. The service has the same specific elements as an
     assessment.
 K680 Substance abuse - extended assessment.................. per unit            80.00
     Payment rules:
     1.K680 is a time based service with time calculated based on units. Unit means ½ hour or
       major part thereof – see General Preamble GP7, GP55 for definitions and time-keeping
       requirements.
      2.No other consultation, assessment, visit or time based service is eligible for payment when
        rendered the same day as K680 to the same patient by the same physician.
      3.K680 is not eligible for payment for management of smoking cessation.
      Medical record requirements:
      Start and stop times must be recorded in the patient's permanent medical record or payment
      will be adjusted to reflect the service documented in the medical record.
      [Commentary:
      See K039 – smoking cessation.]
    Monthly management of a patient in an Opioid Agonist Maintenance Program (OAMP)

Master, record 2917. Record Layout PDF, page 1.

K03920260401999999990000039250000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.