CPT 99407E&M

Behav chng smoking > 10 min

CPT code 99407 covers smoking and tobacco use cessation counseling sessions lasting longer than 10 minutes. This is a preventive service where healthcare providers help patients quit smoking through structured counseling.

Showing rates for

National Average

Base Medicare rate

$26.52

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

0.5

PE RVU (NF)

0.28

MP RVU

0.04

Total RVU

0.82

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 of counseling session to support >10 minute threshold
Impact: Prevents downcoding to 99406 (3-10 minutes, pays $13.26) resulting in $13.26 loss per encounter or 50% payment reduction
Bill 99407 with diagnosis code F17.210 (nicotine dependence, cigarettes, uncomplicated) or appropriate tobacco use disorder code as primary diagnosis
Impact: Ensures medical necessity; incorrect diagnosis coding results in 30-40% denial rate for this service
Medicare covers up to 8 cessation counseling sessions per 12-month period (4 intermediate and 4 intensive sessions) without prior authorization
Impact: Tracking session count prevents denials for exceeding frequency limits; allows maximum annual revenue of approximately $212 per patient for intermediate counseling
Do not bill 99407 on the same day as annual wellness visit (G0438/G0439) unless modifier 25 is appended and documentation supports separate service
Impact: Bundling violations result in automatic denial; proper modifier use preserves $26.52 in revenue per session
For telehealth delivery, ensure patient consent is documented and place of service code is 02 (telehealth) or 10 (patient home via telehealth) per current regulations
Impact: Incorrect POS codes trigger immediate denials; proper coding maintains 100% reimbursement for virtual visits
Commercial payers may require use of modifier 33 to waive patient cost-sharing under ACA preventive services mandates
Impact: Missing modifier 33 may result in patient balance billing issues and practice collection losses; ensures zero patient cost-share compliance

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Frequently asked questions

What is the difference between CPT 99406 and 99407?

CPT 99406 covers smoking cessation counseling lasting 3 to 10 minutes and reimburses $13.26, while 99407 covers counseling exceeding 10 minutes and reimburses $26.52 (2025 Medicare non-facility rates). The key difference is duration; providers must document the exact time to support billing the higher-level code.

How many times can you bill 99407 for the same patient?

Medicare covers up to 8 smoking cessation counseling sessions (99406 or 99407 combined) per 12-month rolling period without prior authorization for beneficiaries diagnosed with tobacco use disorder. After successful abstinence for 12 months, a new series of counseling sessions may be covered if the patient resumes tobacco use.

Can 99407 be billed with an office visit on the same day?

Yes, CPT 99407 can be billed with an office visit (99202-99215) on the same day if modifier 25 is appended to the E&M code and documentation clearly shows the counseling was a significant, separately identifiable service beyond the problem-oriented E&M visit. Both services must meet their respective documentation requirements.

Does Medicare cover CPT 99407 for smoking cessation counseling?

Yes, Medicare covers CPT 99407 as a preventive service with no patient cost-sharing when billed with an appropriate tobacco use diagnosis code. The service is covered for beneficiaries who use tobacco and are asymptomatic or have a disease or condition that may be complicated by tobacco use.

What diagnosis codes are required for billing 99407?

The primary diagnosis should be from the F17.2xx series (nicotine dependence) or Z72.0 (tobacco use). Common codes include F17.210 (nicotine dependence, cigarettes, uncomplicated), F17.200 (nicotine dependence, unspecified), or Z87.891 (personal history of nicotine dependence) for former users seeking relapse prevention counseling.

Can nurse practitioners and physician assistants bill CPT 99407?

Yes, nurse practitioners, physician assistants, and clinical nurse specialists can bill CPT 99407 under their own provider numbers when performing smoking cessation counseling within their scope of practice. Medicare and most commercial payers reimburse these providers at 100% of the physician fee schedule rate for this service.

Is CPT 99407 covered for telehealth visits?

Yes, CPT 99407 is covered for telehealth delivery by Medicare and most commercial payers. When provided via telehealth, append modifier 95, use place of service code 02 or 10 (depending on patient location), and document patient consent for telehealth delivery. The service must still meet the >10 minute face-to-face time requirement via real-time audio-video communication.