99406
Behav chng smoking 3-10 min
Smoking and tobacco-use cessation counseling visit, intermediate, more than 3 minutes up to 10 minutes. CMS 2026 wRVU 0.24. Up to 8 sessions per 12-month period per Medicare beneficiary. 99407 is the analogous code for greater-than-10-minute intensive counseling.
When to use it
Use 99406 for any encounter where you spent 3 to 10 minutes counseling a current tobacco user on cessation. The 5 A's framework (Ask, Advise, Assess, Assist, Arrange) is the documentation backbone; you do not need all five at every visit but document the ones that occurred.
Full guidance
Common settings: a hypertensive smoker at a primary-care follow-up where you advised cessation and discussed pharmacotherapy options; a COPD patient at a pulmonology visit where you assessed readiness and prescribed varenicline; a cardiac patient post-MI where you arranged a referral to a state quitline. The patient must be a current tobacco user (not former). For relapse prevention in an ex-smoker, the work is part of the E/M and is not separately billable as 99406. Time must be documented separately from E/M time; if your E/M counted time toward the 30 to 39 minute 99214 threshold, you cannot also count the cessation minutes toward 99406. The time must be carved out.
Documentation checklist
- ✓Patient identified as a current tobacco user. Specify the form (cigarettes, e-cigarettes, smokeless, cigar, pipe) and the daily quantity or pack-year history.
- ✓Time spent in cessation counseling: between 3 and 10 minutes, documented separately from any E/M time on the same date.
- ✓Content of the counseling using the 5 A's framework: Ask (about tobacco use), Advise (to quit), Assess (readiness to quit), Assist (nicotine replacement, varenicline, bupropion, behavioral support), Arrange (follow-up or referral to quitline).
- ✓If pharmacotherapy was discussed or prescribed, name the agent and indication.
- ✓If a referral was made (e.g., to 1-800-QUIT-NOW), document the referral.
- ✓The 99406 time is separate from the E/M time on the same date; do not double-count.
- ✓ICD-10: F17.210 (cigarette dependence, uncomplicated) or F17.290 (other tobacco dependence) on the claim for the cessation work. Z87.891 (history of nicotine dependence) is for former smokers and is not billable for 99406.
Common pitfalls
- !Billing 99406 for an ex-smoker. The code requires current use. Counseling a quit-confirmed patient at follow-up is part of the E/M, not separately billable.
- !Failing to document time separately from E/M time. If the cessation minutes are folded into the total E/M time, neither code can claim them as separate work.
- !Documenting "discussed cessation" without 5 A's content. The framework is the structural deliverable; without naming the elements (advise, assess, assist), the documentation is thin.
- !Billing more than 8 sessions per 12 months per Medicare beneficiary. The frequency limit is 8 cessation sessions per year combined across 99406 and 99407.
- !Missing the diagnosis code. F17.210 or F17.290 must be on the claim. Z87.891 (history of) is for ex-smokers and is not a billable diagnosis for 99406.
- !Coding 99406 alongside 99407 on the same date for the same encounter. Pick one based on total time: 3 to 10 minutes is 99406; greater than 10 minutes is 99407.
Payer notes
Medicare covers up to 8 cessation-counseling sessions per 12-month period per beneficiary with no cost share when the diagnosis is tobacco dependence (F17.xxx). Medicare Advantage typically follows Medicare. Commercial payers vary widely: many cover unlimited sessions, some apply a copay, some require pre-authorization for pharmacotherapy. Coverage extends to e-cigarette and smokeless tobacco use in most plans. State Medicaid coverage varies; check your state. Telehealth delivery is accepted at POS 02 or POS 10 with modifier 95 for Medicare and most commercial plans.