2025 CPT code 99407
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Behavior Change Interventions Evaluation and Management > Preventive Medicine Services Feed
Smoking and tobacco use cessation counseling; intensive, >10 minutes.
Modifier 25 is used when a significant and separately identifiable E/M service is provided on the same day. Modifiers 33 (Preventive Services) may also apply.
Medical necessity for tobacco cessation counseling is generally established when a patient is actively using tobacco and wishes to quit.The presence of tobacco-related illnesses, such as COPD, lung cancer, cardiovascular disease, or other conditions, will strengthen the medical necessity.
The clinician's responsibilities include conducting a thorough assessment of the patient's tobacco use, understanding the patient's readiness to quit, identifying barriers to quitting, developing a personalized cessation plan, providing motivational counseling, prescribing medications if appropriate, arranging for support groups or other resources, and documenting the entire process.
- Evaluation and Management > Preventive Medicine Services
- Preventive Medicine Services; Behavior Change Interventions
In simple words: This code covers a long talk with a doctor or other healthcare professional about quitting smoking or using tobacco. The session is more than 10 minutes long and includes a discussion about the patient's readiness to quit, finding ways to deal with challenges, and the health benefits of stopping.
This CPT code reports an intensive smoking and tobacco use cessation counseling visit lasting more than 10 minutes.The counseling session involves assessing the patient's readiness for change and identifying barriers to cessation and potential relapse triggers.The provider discusses practical coping mechanisms, the risks of continued tobacco use, and the benefits of quitting, tailored to the patient's specific health status.Pharmacologic interventions may be prescribed, and referrals to support groups may be made.The provider meticulously documents the discussion and the total time spent in counseling.
Example 1: A 55-year-old patient with a 30-pack-year smoking history presents for intensive smoking cessation counseling. The provider spends 20 minutes discussing the patient's smoking habits, motivations for quitting, and barriers to cessation (e.g., stress, social pressure). A personalized plan is developed, including nicotine replacement therapy, stress management techniques, and referral to a support group., A 28-year-old patient with a history of multiple unsuccessful quit attempts seeks intensive counseling. The provider spends 35 minutes exploring underlying psychological factors, including anxiety and depression, which are contributing to the patient's continued smoking. A collaborative plan is developed involving behavioral therapy and pharmacotherapy., A 62-year-old patient with COPD presents for an intensive smoking cessation counseling visit. The provider spends 15 minutes discussing the impact of smoking on their COPD, emphasizing the link between smoking cessation and improved respiratory function. The provider details the risks associated with their current smoking habit and the benefits of quitting, and explores different cessation methods, including medications.
Detailed documentation of the counseling session is essential, including the date, time, duration of the session (should exceed 10 minutes), a description of the counseling techniques used, the patient's readiness for change, barriers to cessation, the plan for cessation, any referrals made, and any medications prescribed. Progress notes should show the patient's tobacco use, attempts to quit, and any related diagnoses.
** Medicare covers two cessation attempts per year, with up to four sessions per attempt.Pay close attention to payer-specific policies regarding coverage and reimbursement.
- Revenue Code: M5D (Specialist - Other)
- RVU: The RVUs and reimbursement rates vary based on payer and location.Medicare rates have historically been around $28.96 in 2021, but this is subject to change.
- Global Days: Not applicable.
- Payment Status: Active (as of December 3, 2024)
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is unavailable. Consult payer-specific historical data for reference.
- Specialties:Pulmonology, Cardiology, Oncology, Family Medicine, Internal Medicine, Psychiatry
- Place of Service:Office, Outpatient Hospital, Urgent Care Facility, Telehealth