Behav chng smoking 3-10 min
CPT code 99406 is used when a healthcare provider spends 3 to 10 minutes counseling a patient about quitting smoking or using tobacco products. This brief intervention focuses on behavioral change strategies to help patients reduce or stop tobacco use.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times or total duration of counseling in the medical record
Impact: Time documentation is the primary audit target; missing times result in 85% of denials and downcoding to lower-value preventive codes
Bill 99406 with modifier 25 when provided during a separate E/M visit on the same day
Impact: Captures additional $13.91 revenue that would otherwise be lost; ensure distinct documentation for each service
Use diagnosis code F17.210 (nicotine dependence, cigarettes, uncomplicated) or appropriate F17.2xx code as primary
Impact: Tobacco use disorder codes (F17.2xx) have higher approval rates than symptom codes; improves first-pass claim acceptance by 30%
Do not bill 99406 and 99407 on the same date of service; choose based on actual time spent
Impact: Billing both codes results in automatic denial; 99407 pays $27.81 for >10 minutes, nearly double the 99406 rate
Bill up to 4 counseling sessions per rolling 12-month period per Medicare guidelines
Impact: Medicare covers 8 sessions annually (2 attempts of 4 sessions each); tracking utilization prevents denials and maximizes $55.64 annual potential per patient
Verify if your state Medicaid program requires prior authorization or uses HCPCS G-codes instead of CPT codes
Impact: Some Medicaid programs use G0436/G0437 for tobacco cessation; billing wrong code results in 100% claim rejection
Common denials
Insufficient time documentation - no start/stop times or total duration recorded
How to appeal: Submit medical record excerpt showing time documentation; if time was documented verbally but not written, submit provider attestation with corrected record and request one-time consideration
Frequency limit exceeded - more than 8 sessions billed within 12 months
How to appeal: Review claim history to verify actual session count; if sessions were for separate quit attempts, submit clinical notes documenting relapse and new cessation attempt with medical necessity statement
Missing or inappropriate diagnosis code - billed without tobacco use disorder code
How to appeal: Submit corrected claim with appropriate F17.2xx code; include clinical documentation confirming tobacco use and counseling provided
Bundled with E/M service - denied as inclusive when billed same day without modifier 25
How to appeal: Resubmit claim with modifier 25 appended to E/M code; provide documentation showing counseling was separate and distinct from E/M service with different focus and additional time
Frequently asked questions
How much does Medicare pay for CPT code 99406 in 2025?
Medicare pays $13.91 for CPT 99406 in non-facility settings and $11.32 in facility settings based on the 2025 Physician Fee Schedule. The total RVU is 0.43 with a conversion factor of 32.3465.
What is the difference between CPT 99406 and 99407?
CPT 99406 is for smoking cessation counseling lasting 3 to 10 minutes, while 99407 covers counseling sessions longer than 10 minutes. The time threshold determines which code to use, and only one code should be billed per session based on actual documented time.
How many times can you bill 99406 per year?
Medicare allows up to 8 smoking cessation counseling sessions per 12-month period, covering 2 quit attempts per year with up to 4 sessions per attempt. Both 99406 and 99407 count toward this 8-session annual limit.
Can CPT 99406 be billed with an office visit?
Yes, CPT 99406 can be billed with a separate E/M office visit on the same day, but you must append modifier 25 to the E/M code and document that the counseling was a separate, identifiable service beyond the E/M encounter.
What diagnosis code should I use with CPT 99406?
Use ICD-10 codes from the F17.2xx series for nicotine dependence (such as F17.210 for cigarette dependence, uncomplicated) or Z87.891 for personal history of nicotine dependence. The specific tobacco product type should match the patient's use pattern.
Is CPT 99406 covered by Medicare without a copay?
Yes, Medicare covers smoking cessation counseling (99406 and 99407) as a preventive service with no coinsurance, copayment, or deductible when billed with appropriate diagnosis codes and the patient is asymptomatic for tobacco-related illness.
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 NPI when performing smoking cessation counseling within their scope of practice, and Medicare reimburses at 100% of the physician fee schedule rate.