Reimbursement
$13.36
Threshold
N/A
2026 Status
Active
What is CPT Code 99406?
CPT 99406 is defined as: An intermediate-level smoking and tobacco use cessation counseling visit lasting between 3 and 10 minutes. This preventive service involves providing specific advice to stop smoking, assessing the patient's readiness to quit, and developing a cessation plan. It is intended for patients who use tobacco and are ready to receive counseling, whether they have symptoms of a tobacco-related disease or not.
This code is primarily used for Preventive services. It falls under the category of Preventive Medicine and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.24
Physician Effort
PE (Non-Fac)
0.15
Practice Expense
Malpractice
0.01
Risk Factor
Total RVU
0.4
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% efficiency adjustment. CMS continues to incentivize preventive services that reduce long-term chronic disease costs.
audio only permanent
As a time-based preventive/behavioral service, 99406 is permanently eligible for audio-only delivery, supporting patients in areas with poor internet connectivity.
conversion factor
Utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
time threshold
The face-to-face (or telehealth) time spent exclusively on tobacco cessation counseling must be greater than 3 minutes but not more than 10 minutes. If the time exceeds 10 minutes, bill 99407 instead.
annual limit
Medicare typically covers up to 8 counseling sessions per 12-month period (two attempts per year, 4 sessions per attempt).
cost sharing
$0 coinsurance and $0 deductible apply for Medicare beneficiaries, regardless of whether they have signs or symptoms of a tobacco-related disease.
documentation content
The note must include the total time spent, the counseling techniques used (e.g., 'The 5 A's'), and the specific cessation plan discussed.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Exempt from the mandatory -2.5% efficiency cut. $0 patient cost-sharing for all Medicare beneficiaries.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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