Office or Outpatient Setting for Intensive Tobacco Cessation Counseling
CPT® code 99407 is used to report an intensive, face-to-face counseling session lasting more than 10 minutes, focused on smoking and tobacco use cessation. This service involves structured behavioral interventions designed to assess the patient’s readiness to quit, address dependence, discuss pharmacologic aids, and develop a personalized quit plan. It applies in both office and outpatient settings and is intended for patients actively using tobacco products.
When to Use CPT® Code 99407
Report 99407 when:
- The provider delivers more than 10 minutes of tobacco cessation counseling during a single encounter.
- The counseling includes personalized assessment, goal setting, and education on cessation strategies.
- The session is separate from routine evaluation and management (E/M) services, or is distinctly identifiable with proper modifier use.
- The service is provided by a qualified healthcare professional such as a physician, nurse practitioner, or clinical psychologist.
For shorter sessions lasting 3–10 minutes, use CPT® 99406 instead.
Documentation Requirements
Comprehensive documentation is required to support billing of 99407, including:
- Duration of counseling (must exceed 10 minutes)
- Topics discussed (e.g., health risks, cessation strategies, pharmacotherapy options)
- Patient’s tobacco use history and readiness to quit
- Interventions or resources provided (e.g., nicotine replacement therapy, support referrals)
- Provider credentials, signature, and date of service
Document the total time spent and ensure the note clearly differentiates the counseling from any other E/M service performed the same day.
Billing Guidelines
- 99407 may be billed as a stand-alone service or in conjunction with an E/M code using modifier -25 when appropriate.
- Payers often allow two cessation counseling sessions per year, though frequency limits vary.
- The session must be face-to-face—telephone or digital communications are not billable under this code.
- Both Medicare and commercial payers may require documentation of tobacco use status and counseling duration for reimbursement.
- Use diagnosis code Z72.0 (tobacco use) or F17.200–F17.299 (nicotine dependence) to support medical necessity.
Example
A provider spends 15 minutes counseling a patient who smokes one pack per day about the health effects of tobacco use and the benefits of quitting. The provider develops a quit plan, prescribes nicotine replacement therapy, and provides educational resources. The encounter is billed using CPT® code 99407, supported by time and content documentation.
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