CPT 99406E&M

Behav chng smoking 3-10 min

CPT 99406 is used when a healthcare provider spends 3 to 10 minutes counseling a patient about quitting smoking or using tobacco products. This is a brief, focused intervention aimed at helping patients stop tobacco use.

Showing rates for

National Average

Base Medicare rate

$13.91

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.24

PE RVU (NF)

0.17

MP RVU

0.02

Total RVU

0.43

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact start and stop times for the counseling session to substantiate the 3-10 minute timeframe
Impact: Prevents denials due to insufficient time documentation; time-based billing audits result in 30-40% denial rates without specific timestamps
Bill 99406 separately from E&M visits using modifier 25, ensuring documentation reflects two distinct services
Impact: Captures additional $13.91 per encounter that would otherwise be lost; represents potential annual revenue increase of $5,000-$15,000 per provider
Check Medicare and commercial payer policies on frequency limitations; most allow up to 8 sessions per year for tobacco cessation
Impact: Medicare covers 8 counseling attempts over 12-month period; exceeding limits results in 100% denial
Do not bill 99406 on the same date as 99407 (longer counseling session); bill only the code matching actual time spent
Impact: Billing both codes results in automatic denial of one service; proper selection ensures correct payment of either $13.91 or $25.14
Use diagnosis codes Z71.6 (tobacco abuse counseling) or F17.2xx (nicotine dependence) to support medical necessity
Impact: Appropriate diagnosis coding reduces denial risk by 25-35%; Z71.6 is optimal for preventive counseling claims
For telehealth services, verify current payer policy as coverage expanded during PHE but some limitations have returned
Impact: Telehealth denials account for 20% of 99406 rejections post-PHE; pre-verification prevents revenue loss

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Frequently asked questions

What is the difference between CPT 99406 and 99407?

CPT 99406 is for smoking cessation counseling lasting 3 to 10 minutes, reimbursed at $13.91, while 99407 covers counseling sessions greater than 10 minutes, reimbursed at approximately $25.14. You should bill only the code that matches the actual documented time spent in counseling.

Can I bill 99406 with an office visit on the same day?

Yes, you can bill 99406 with a separate E&M service on the same day by appending modifier 25 to the E&M code. Documentation must clearly show that the tobacco counseling was a separately identifiable service from the primary reason for the visit, with distinct time allocation and documentation.

How many times per year can I bill CPT 99406 for Medicare patients?

Medicare covers up to 8 smoking cessation counseling attempts (sessions) within a 12-month period. This includes both intermediate (99406) and intensive (99407) counseling sessions combined. Each attempt can include up to 4 intermediate or intensive sessions, but total cannot exceed 8 sessions per year without special documentation.

What diagnosis codes should I use with CPT 99406?

The primary diagnosis codes for 99406 are Z71.6 (tobacco abuse counseling) for preventive counseling or F17.2xx codes for nicotine dependence. Z71.6 is typically preferred for screening and counseling services, while F17.2xx codes specify the type of tobacco product and dependence level.

Does CPT 99406 require the patient to have a tobacco-related illness?

No, CPT 99406 does not require the patient to have an existing tobacco-related illness. This is a preventive service covered for any tobacco user, regardless of whether they have smoking-related health conditions. The USPSTF Grade A recommendation supports counseling for all tobacco users.

Can nurse practitioners and physician assistants bill CPT 99406?

Yes, nurse practitioners, physician assistants, and clinical nurse specialists can bill CPT 99406 under their own provider numbers if they are credentialed with the payer and working within their scope of practice. Reimbursement rates are the same as for physicians in most cases, though some states may have supervision requirements.

Is CPT 99406 covered via telehealth?

Yes, CPT 99406 is covered via telehealth by Medicare and many commercial payers, though policies vary. Use modifier 95 or GT (depending on payer) to indicate telehealth delivery. During and after the COVID-19 public health emergency, coverage has been maintained for tobacco cessation counseling via telehealth, but verify current payer-specific policies as regulations continue to evolve.