What is smoking cessation counseling?
Smoking cessation counseling is a structured behavioral intervention aimed at helping individuals quit smoking and tobacco use. The 99406 CPT code specifically refers to a tobacco use cessation counseling visit that lasts between 3 and 10 minutes.
During these sessions, healthcare providers assess the patient’s readiness to quit, explain the health risks of tobacco, recommend cessation strategies, and provide ongoing support.
CPT 99406 is reimbursable under Medicare and Medicaid Services, including Medicare Part B, when documentation supports medical necessity. This service is particularly impactful for people with behavioral health challenges, who are at a higher risk for tobacco-related illnesses.
Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) emphasize the importance of addressing tobacco use in this population (CDC, 2024).
When to use CPT code 99406
Healthcare professionals should report tobacco cessation counseling using 99406 when:
- Counseling lasts 3–10 minutes
- The patient is an active tobacco user
- A formal counseling session is conducted to help the patient quit
- The provider documents time, content, and patient response
This appropriate tobacco cessation code supports public health efforts in tobacco use prevention, cessation, and control, as emphasized by the CDC, Smoking Cessation Leadership Center, and National Coverage Determination (NCD) guidelines. For longer sessions over 10 minutes, CPT code 99407 should be used instead.
Documentation requirements
When billing the CPT code 99406 for tobacco use cessation counseling, documentation must meet Medicare and payer guidelines to support medical necessity and proper reimbursement.
The following elements are accurate and essential; here they are with brief clarification and keyword integration:
- Tobacco use status: Document whether the patient uses tobacco (e.g., type, frequency, duration). This supports the need for smoking and tobacco use cessation counseling.
- Counseling provided (e.g., risks, strategies, support): Describe the tobacco cessation counseling content discussed, such as health risks, behavioral strategies, cessation resources, or support referrals. This aligns with substance abuse and mental health prevention efforts.
- Duration of the session (3–10 minutes): Accurately record that the cessation counseling visit lasted between 3–10 minutes, which is a key billing requirement for the 99406 CPT code under Medicare and Medicaid Services.
- Patient response and plan (e.g., quit date, resources offered): Note the patient’s engagement, any stated quit date, referrals to support programs like the Smoking Cessation Leadership Center, or use of tobacco cessation services connect platforms. This helps show follow-through in behavioral counseling for cessation.
Billing guidelines
You may report the 99406 CPT code once per encounter when the tobacco use cessation counseling session lasts 3–10 minutes and meets the time and documentation requirements. If the counseling session exceeds 10 minutes, use CPT code 99407 instead.
99406 can be billed alongside an evaluation and management (E/M) service when the counseling is separately identifiable; in that case, append modifier -25 to the E/M code. This ensures compliance with the Correct Coding Initiative (NCCI) and supports accurate billing coding and documentation.
This use cessation counseling service is covered under Medicare Part B and many commercial insurance plans when it is medically necessary, particularly for smoking and tobacco use cessation counseling among patients with behavioral health conditions or substance abuse and mental health concerns.
Proper reporting of tobacco cessation counseling services supports national efforts for disease control and prevention, especially among people with behavioral health risks.
Reference
Centers for Disease Control and Prevention. (2024, August 27). Commercial tobacco product use and behavioral health conditions can affect each other. https://www.cdc.gov/tobacco-health-equity/collection/behavioral-health-interactions.html?
Frequently asked questions
Yes, you can bill the 99406 CPT code with an evaluation and management (E/M) service if the tobacco use cessation counseling is a separately identifiable service. In such cases, append modifier -25 to the E/M code to indicate distinct counseling beyond the typical scope of the visit.
Yes, documentation of the duration is essential when billing the 99406 CPT code. The provider must record that the smoking and tobacco use cessation counseling lasted between 3–10 minutes. Without this, the cessation counseling visit may be denied or bundled under the E/M service.
Time-based documentation supports compliance with Medicare and Medicaid Services (CMS) and coding and documentation guidance protocols.
Yes, Medicare Part B covers 99406 for symptomatic tobacco users or those with tobacco-related conditions, such as chronic bronchitis, COPD, or cardiovascular disease. Coverage includes up to two cessation attempts per year, with each attempt allowing four intermediate or intensive sessions, totaling eight sessions annually.
The service must be furnished by a qualified provider and meet medical necessity criteria established by Medicare and Medicaid Services CMS and supported by a cessation counseling plan.
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