Summary & Overview
CPT 99407: Tobacco Cessation Counseling >10 Minutes
CPT code 99407 designates clinician-provided tobacco cessation counseling sessions that exceed 10 minutes. This preventive behavioral counseling code is used when clinicians deliver focused intervention to help patients stop tobacco use, an evidence-based service with implications for population health and chronic disease prevention. Nationally, tobacco cessation counseling is prioritized across public and private payers as part of preventive care strategies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context and clinical intent, typical sites of service, and how 99407 is positioned among tobacco cessation services. The publication also outlines common modifiers and payer considerations where available, benchmarks for counseling duration coding, and policy updates affecting coverage and documentation requirements.
This summary is intended to help billing professionals, clinicians, and policy analysts quickly understand the purpose of CPT code 99407, the clinical setting in which it is commonly used, and the payer landscape relevant to national reimbursement and coverage practices.
Billing Code Overview
CPT code 99407 describes tobacco cessation counseling provided by a clinician when the counseling session lasts more than 10 minutes. The service focuses on counseling the patient on how to stop tobacco use, including behavioral strategies, motivation, and brief intervention techniques.
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Service type: Preventive / behavioral counseling service
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Typical site of service: Outpatient clinic or office-based setting, including primary care and specialty ambulatory clinics
Data not available in the input for associated taxonomies, ICD-10 diagnoses, or related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who uses combustible tobacco or nicotine products and presents to primary care, family medicine, internal medicine, or a designated tobacco cessation clinic requesting help to quit. The patient is evaluated during an office visit where the clinician documents tobacco-use status, assesses readiness to quit, reviews prior quit attempts, and provides structured counseling lasting more than 10 minutes. Counseling includes behavioral strategies, setting a quit date, development of a quit plan, discussion of pharmacotherapy options (nicotine replacement therapy, bupropion, varenicline), and arranging follow-up. The workflow: intake staff flags current tobacco users; rooming nurse documents tobacco history; clinician or trained counselor conducts the >10-minute cessation counseling session, documents duration and content, adds appropriate ICD-10 diagnosis for tobacco use or dependence, and selects 99407 for billing when counseling exceeded 10 minutes. Typical sites of service include outpatient clinic exam rooms, behavioral health clinics integrated in primary care, and specialized smoking cessation programs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of a procedure | Use when a separate evaluation or management visit is provided in addition to the tobacco cessation counseling on the same day. |