Summary & Overview
CPT 99406: Tobacco Cessation Counseling, 3–10 Minutes
CPT code 99406 covers brief tobacco cessation counseling delivered by a clinician for more than three minutes and up to 10 minutes. This counseling encounter is an important preventive service aimed at reducing tobacco-related morbidity and mortality and is commonly billed in ambulatory and primary care settings. Nationally, services like these support public health goals and are frequently incorporated into primary care workflows and preventive care metrics.
The analysis includes common national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical context for its use, and the typical service settings where it is billed. The publication summarizes benchmark considerations, common modifiers associated with billing practice, and the clinical documentation elements that justify the time-based service. It also outlines how this counseling fits into preventive care workflows and payer coverage patterns.
This summary equips clinicians, coders, and administrators with a clear understanding of the code’s purpose, where it is used, and what to expect from payer coverage and reporting for brief tobacco cessation counseling.
Billing Code Overview
CPT code 99406 describes a tobacco cessation counseling service in which the provider counsels the patient on how to stop tobacco use for more than three minutes, up to 10 minutes. This is a short, structured counseling interaction focused on assisting patients to prepare for and begin cessation efforts.
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Service type: Behavioral counseling / preventive counseling
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Typical site of service: Outpatient clinic or office visit, primary care setting, or other ambulatory care locations where brief counseling can be delivered during a clinical encounter
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who uses tobacco and presents during a primary care visit expressing interest in quitting or identified by screening as a current tobacco user. The visit occurs in an outpatient clinic or office setting where the clinician (physician, advanced practice nurse, or physician assistant) conducts a focused counseling session lasting more than three minutes and up to ten minutes to advise cessation, assess readiness, discuss strategies (behavioral counseling, pharmacotherapy options such as nicotine replacement, varenicline, or bupropion), and arrange follow-up. The clinical workflow includes tobacco use screening at check-in, documentation of current tobacco status in the medical record, the clinician delivering the brief counseling (99406) during the visit, coding the service on the claim, and scheduling follow-up or referral to a tobacco cessation program as appropriate. Typical sites of service are office/outpatient clinics, community health centers, and behavioral health integrated primary care settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service | Use when a distinct evaluation/management visit is provided in addition to 99406 on the same day and documentation supports separate services |