99407
Behav chng smoking > 10 min
Smoking and tobacco-use cessation counseling visit, intensive, greater than 10 minutes. CMS 2026 wRVU 0.50. Up to 8 sessions per 12-month period per Medicare beneficiary. The intensive counterpart to 99406 (3 to 10 minutes intermediate counseling).
When to use it
Use 99407 when tobacco cessation counseling lasts more than 10 minutes. Common settings: a dedicated cessation visit for a motivated quitter, a pre-operative cessation counseling encounter for upcoming surgery, a post-MI cessation counseling encounter, an oncology cessation visit during cancer treatment.
Full guidance
The 5 A's framework (Ask, Advise, Assess, Assist, Arrange) provides the documentation backbone, particularly the Assist and Arrange steps when more time is invested (pharmacotherapy planning, follow-up scheduling, quitline referral). Patient must be a current tobacco user; for former smokers, the counseling is part of the E/M, not separately billable.
Documentation checklist
- ✓Patient is a current tobacco user (cigarettes, e-cigarettes, smokeless, cigar, pipe), with type and quantity documented.
- ✓Time spent in cessation counseling: more than 10 minutes, documented separately from any E/M time on the same date.
- ✓Content using the 5 A's framework, with emphasis on Assist (pharmacotherapy plan, behavioral support, nicotine replacement) and Arrange (follow-up scheduling, quitline referral, multidisciplinary referral).
- ✓If pharmacotherapy was prescribed, document the agent (varenicline, bupropion, NRT) and the indication.
- ✓If a referral was made (1-800-QUIT-NOW, state quitline, behavioral health), document the referral.
- ✓The 99407 time is separate from E/M time on the same date.
- ✓ICD-10: F17.210 (cigarette dependence, uncomplicated) or F17.290 (other tobacco dependence) on the claim.
Common pitfalls
- !Billing 99407 with only 5 to 10 minutes documented. That's 99406 territory. Pick by total time.
- !Documenting "tobacco counseling" without time. Time is the primary structural deliverable; absence is a denial.
- !Billing 99407 alongside 99406 on the same date for the same encounter. Pick one based on total time.
- !Exceeding 8 sessions per 12 months per Medicare beneficiary (combined across 99406 and 99407).
- !Billing for ex-smokers. The code requires current use. Counseling a confirmed quit patient at follow-up is part of the E/M, not separately billable.
- !Failing to document time separately from E/M time when the encounter included problem-oriented work. The minutes can't double-count.
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. Medicare Advantage typically follows. Commercial coverage varies: many cover unlimited sessions, some apply copay. Telehealth delivery accepted at POS 02 or POS 10 with modifier 95 on most plans. The 99407 wRVU is roughly twice 99406; longer counseling pays better.