Behav chng smoking > 10 min
CPT code 99407 is used when a healthcare provider spends more than 10 minutes counseling a patient on how to quit smoking or using tobacco products. This is an intensive behavioral intervention session focused on helping the patient develop strategies to stop tobacco use.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document the exact start and stop time of the counseling session to support the >10 minute requirement
Impact: Prevents denials due to insufficient time documentation; each session must exceed 10 minutes to avoid downcoding to 99406 which pays $12.98 less
Bill 99407 separately from E&M visits using modifier 25 when both services are provided on the same day
Impact: Captures additional $26.52 revenue that would otherwise be lost if bundled into the E&M visit
Medicare covers 8 counseling sessions per year (4 intermediate or intensive sessions in a 12-month period, repeated once)
Impact: Understanding coverage limits prevents claim denials and allows scheduling optimization to maximize the $212.16 annual potential per patient
Use diagnosis codes from ICD-10 categories F17.2xx (nicotine dependence) or Z71.6 (tobacco abuse counseling) as primary diagnosis
Impact: Correct diagnosis coding is required for coverage; Z87.891 (personal history of tobacco use) alone may trigger denials
Bill in non-facility settings when possible to capture the higher rate
Impact: Non-facility rate is $26.52 vs. facility rate of $23.94, yielding $2.58 more per session (10.8% increase)
Do not bill 99407 with 99406 on the same date of service for the same patient
Impact: These codes are mutually exclusive based on time; billing both results in automatic denial and audit risk
Common denials
Insufficient documentation of time spent on counseling (failure to document >10 minutes)
How to appeal: Submit appeal with corrected documentation showing start/stop times or total minutes spent. Include counseling note with timestamp and detailed intervention content. Reference CMS guidelines that 99407 requires greater than 10 minutes of face-to-face time.
Frequency limits exceeded (more than 8 sessions per 12-month period billed)
How to appeal: Review claim history to verify actual session count. If patient qualifies for a new 12-month period, submit documentation showing date ranges. If sessions were medically necessary beyond limits, submit letter of medical necessity explaining unique circumstances and request exception.
Missing or incorrect diagnosis code (no tobacco use disorder or counseling code listed)
How to appeal: Resubmit claim with appropriate ICD-10 code: F17.210 (nicotine dependence, cigarettes, uncomplicated) or Z71.6 (tobacco abuse counseling). Include clinical note documenting tobacco use status and counseling provided.
Bundled with E&M service due to missing modifier 25
How to appeal: Submit corrected claim with modifier 25 appended to the E&M code (not to 99407). Include documentation showing the E&M service addressed a separate, significant medical issue distinct from the tobacco cessation counseling.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 99407 in 2025?
Medicare pays $26.52 for CPT 99407 in non-facility settings and $23.94 in facility settings based on the 2025 Physician Fee Schedule. The code has a total RVU of 0.82 (0.5 work RVU, 0.28/0.2 PE RVU, 0.04 MP RVU) multiplied by the 2025 conversion factor of 32.3465.
How long must smoking cessation counseling last to bill CPT 99407?
CPT 99407 requires counseling to last greater than 10 minutes. If the session is 3-10 minutes, use CPT 99406 instead. You must document the exact time spent or start/stop times in the medical record to support the claim.
Can I bill 99407 with an office visit on the same day?
Yes, you can bill CPT 99407 with an E&M office visit (such as 99213 or 99214) on the same day if the counseling is a separate, distinct service. Append modifier 25 to the E&M code and document that the E&M addressed a different medical issue from the tobacco cessation counseling.
How many times can CPT 99407 be billed per year?
Medicare covers up to 8 smoking cessation counseling sessions per 12-month period. This consists of 4 intermediate or intensive sessions (99406 or 99407) in the first attempt, and if unsuccessful, 4 additional sessions in a second attempt. The 12-month period begins with the first counseling session.
What diagnosis codes should I use with CPT 99407?
Use ICD-10 codes F17.2xx for nicotine dependence (such as F17.210 for cigarette dependence) or Z71.6 for tobacco abuse counseling. You may also include Z87.891 (personal history of nicotine dependence) as a secondary code, but it should not be the sole diagnosis.
Is CPT 99407 covered by Medicare without patient cost-sharing?
Yes, smoking cessation counseling (CPT 99407) is covered as a preventive service under Medicare with no deductible or copayment when billed with appropriate tobacco-related diagnosis codes and when the beneficiary does not have symptoms of tobacco-related disease. Use modifier 33 if required by the payer.
Can nurse practitioners and physician assistants bill CPT 99407?
Yes, nurse practitioners (NPs), physician assistants (PAs), clinical nurse specialists (CNS), and clinical psychologists can bill CPT 99407 independently under Medicare. They must perform the service within their scope of practice and state licensure requirements. Billing occurs under their own NPI number.