2025 CPT code 99406
(Active) Effective Date: N/A Evaluation and Management - Preventive Medicine Services Feed
Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
Modifier 25 can be used if a significant, separately identifiable E/M service is provided on the same day.
Medical necessity is established by the patient's tobacco use and desire to quit. It is important to document tobacco use status and the patient's willingness to engage in cessation efforts.
The physician or other qualified healthcare professional counsels the patient on how to stop using tobacco products. They will explore barriers to cessation, relapse triggers, and coping strategies. They may prescribe medication or refer the patient to support groups.
In simple words: The doctor provides counseling to help you quit smoking or using tobacco. This session lasts between 3 and 10 minutes.
This code represents a counseling session with a patient for smoking and tobacco use cessation, lasting between 3 and 10 minutes.The counseling should include discussion of barriers to cessation, relapse triggers, and practical coping methods.It may also include prescriptions for pharmacologic interventions or referrals to support groups.
Example 1: A patient sees their primary care physician for an annual check-up and expresses a desire to quit smoking. The physician spends 5 minutes counseling the patient on different cessation strategies and prescribes a nicotine patch., A patient with chronic bronchitis visits their pulmonologist.The physician counsels the patient for 8 minutes on the benefits of quitting smoking and refers them to a local support group., A pregnant patient visits her OB/GYN and is concerned about the effect of smoking on her pregnancy. The physician provides 10 minutes of counseling on smoking cessation strategies specific to pregnancy.
Documentation must include the duration of the counseling session, the topics discussed (e.g., barriers to cessation, coping strategies), any interventions provided (e.g., prescriptions, referrals), and the patient's response.
** This information is current as of December 1, 2024.Coding guidelines and reimbursement policies are subject to change, and it is essential to stay up-to-date on the latest information.
- RVU: 0.45 (2021 Medicare Rates)
- Specialties:Family Medicine, Internal Medicine, Obstetrics/Gynecology, Pulmonology, Cardiology, Oncology, and other specialties that provide preventive care.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, telehealth services and other places as deemed appropriate.