CPT 99406 in medical billing is used for intermediate smoking and nicotine cessation counseling, lasting 3–10 minutes. This code is billed when a healthcare provider speaks with a patient about their nicotine use, educates them on risks, and provides brief counseling on strategies to quit.
Providers commonly use it in:
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Primary care
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Urgent care
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Outpatient clinics
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Preventive care visits
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Chronic condition follow-ups
It is important to understand that CPT 99406 only covers the counseling service not medications, nicotine replacement, or treatment management.
Many providers who offer preventive services such as annual physicals also report smoking cessation counseling. For example, clinics that already use preventive visit codes like CPT 99395 or CPT 99396 often add CPT 99406 when counseling is provided during the visit. If you need help with accurate coding, documentation, or claim submission, a medical billing company in Florida can ensure CPT 99406 is billed correctly and reimbursed without issues.
Billing Requirements for CPT 99406
To bill smoking cessation counseling, documentation must show:
✔ Patient Eligibility
The patient must be a current nicotine user and willing to discuss cessation options.
✔ Covered Diagnoses
Use accurate nicotine dependence ICD-10 codes such as:
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F17.210 – Nicotine dependence, cigarettes
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F17.200 – Nicotine dependence, unspecified
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Z72.0 – Nicotine use
Pairing the right diagnosis code is critical to avoid denials, especially when billing Medicare smoking cessation counseling.
✔ Time Requirement
CPT 99406 requires 3–10 minutes of face to face or telehealth counseling.
For counseling beyond 10 minutes, consider CPT 99407, which is often billed for more intensive sessions.
✔ Documentation Essentials
To avoid claim denials, documentation must include:
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History of nicotine use
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Discussion of risks
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Counseling time spent
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Cessation strategies reviewed
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Patient’s readiness to quit
These documentation requirements are similar to what you would record when billing other evaluation codes like CPT 99204 or CPT 99203, where time and medical necessity matter.
Documentation Needed to Avoid Denials
One of the most common denial reasons in smoking cessation billing is missing documentation. Your notes should clearly show:
1. History of Nicotine Use
Example:
"Patient smokes one pack/day for 12 years."
2. Counseling Time
Example:
"Provided 6 minutes of smoking cessation counseling."
3. Methods Discussed
Examples include:
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Nicotine patches
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Avoiding triggers
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Quitline counseling
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Behavioral modification
4. Readiness to Quit
Example:
"Patient is motivated to quit within the next 30 days."
These details support medical necessity and reduce medical billing errors, improving revenue cycle performance.
Reimbursement for CPT 99406
Reimbursement for CPT 99406 in medical billing varies by payer, but typical ranges include:
Medicare (National Average):
$13–$20 depending on locality and POS.
Medicare covers two cessation attempts per year, each including up to four counseling sessions.
Commercial Insurance:
$15–$30 depending on:
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State
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Insurance plan
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Provider specialty
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Place of service
Reimbursement often improves when providers bill preventive services together similar to how providers bundle preventive codes such as CPT 99397 with other services.
Common Denial Reasons & How to Avoid Them
1. Missing Counseling Time
Always document exact minutes.
2. Incorrect Diagnosis Code
Using a non-nicotine diagnosis results in instant denial.
3. Counseling Less Than 3 Minutes
Below the threshold = not billable.
4. Wrong POS Code
Telehealth claims may require specific location modifiers.
5. Missing Provider Signature or Credentials
Especially important for RNs and MAs.
Many of these denial patterns are similar to those seen in office visit codes, including denials for codes like CPT 99214 or CPT 99213.
When to Use CPT 99406 vs CPT 99407
| Code | Time Spent | Service Level |
|---|---|---|
| 99406 | 3–10 minutes | Intermediate counseling |
| 99407 | >10 minutes | Intensive counseling |
Use CPT 99406 when providing brief or intermediate sessions.
Use CPT 99407 when sessions require deeper behavioral therapy or complex discussion.
Real Experience from Our Billing Team
A primary care clinic in Texas reached out to our billing team because their CPT 99406 claims were repeatedly denied. After reviewing their notes, we found three major problems:
1. Counseling Time Not Documented
Providers wrote:
"Discussed smoking with patient."
No time = instant denial.
2. Wrong Diagnosis Code
They used Z71.6 (nicotine abuse counseling) instead of F17.210.
3. Counseling Included with a Preventive Visit But Not Separated
When smoking cessation is performed during a preventive visit such as CPT 99395 it must still include time documentation.
The Fix
We updated their templates to include:
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Automatic time field
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Pre-loaded smoking cessation ICD-10 set
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Standardized phrasing for counseling
Within two billing cycles, their approval rate jumped from 62% to 98%, and average reimbursement increased by 27%.
This is a perfect example of how correct documentation for CPT 99406 directly impacts revenue cycle improvement.
How eServMD Helps with CPT 99406 Billing
At eServMD, our billing experts help providers avoid common problems in medical billing for counseling, including:
✔ Documentation Review
We ensure every note meets payer requirements.
✔ Coding Accuracy Checks
We verify ICD-10 pairing, time thresholds, and correct CPT selection.
✔ Faster Claim Submission
Our system checks for missing elements before claims are sent.
✔ Denial Management
We catch issues early, file corrected claims, and reduce counseling claim denials.
If you want full support, including preventive visit billing or office visit coding, you can explore related guides:
To streamline your billing process or improve reimbursement for CPT 99406, you can also:
Final Takeaway
CPT 99406 in medical billing is one of the most commonly underpaid counseling codes not because payers don’t cover it, but because documentation is often incomplete. When billed correctly, it improves patient health outcomes and boosts provider revenue.
By following the guidelines above, using accurate time documentation, selecting proper ICD-10 diagnoses, and understanding payer rules, clinics can significantly improve claim approvals.
FAQs – CPT 99406 in medical billing?
1. What is CPT 99406 in medical billing?
CPT 99406 in medical billing is used for 3–10 minutes of smoking cessation counseling, helping providers document and bill for brief intervention services.
2. What documentation is required for CPT 99406?
For CPT 99406 documentation requirements, include total time, counseling details, patient readiness to quit, and nicotine dependence diagnosis.
3. What diagnosis code is used with CPT 99406?
The most common secondary diagnosis codes include F17.200–F17.299 for nicotine dependence, required for proper CPT 99406 billing.
4. How do CPT 99406 and CPT 99407 differ?
CPT 99406 vs 99407 differs mainly by time and intensity: 99406 is 3–10 minutes, while 99407 is >10 minutes, reflecting higher complexity.
5. Does Medicare pay for CPT 99406?
Yes, Medicare covers CPT 99406 when criteria are met, including proper documentation, diagnosis, and counseling time.
