It is known that facilitating smoking cessation for patients is one of the critical components in their health care plan. The cause is that smoking is related to a multifactorial of dangerous and long-lasting conditions. Many therapists offer smoking cessation counselling to assist patients in overcoming the habit. For them to receive payment for such services, appropriate codes must be billed. In this case, two of the most appropriate codes are CPT 99406 and 99407.
Codes such as these are essential since access to proper payments is maintained, claim denials appear less often, and regulations are more easily adhered to. This is a step-by-step manual that explains how to apply CPT code 99406 and CPT code 99407 together with cessation services.
CPT 99406: Know the Essentials
The CPT 99406 code description describes that it is the mid-length tobacco cessation code. It is used when the doctor spends three to ten minutes (average 7 minutes) with patients discussing the risks of tobacco and counselling them to help them quit this habit.
Who is eligible to bill 99406?
Any person who holds a license in health care and renders services in tobacco cessation counselling, such as:
· Physicians
· Nurse Practitioners
· Physician Assistants, along with other Undisclosed Accredited Behavioural Health Professionals
Most frequent use cases of 99406
· A doctor spends about 3-10 minutes discussing the risks of due to tobacco and suggesting nicotine replacement therapy.
· A nurse practitioner sets a quit date with the patient using the local Quitline.
· Within the scope of an ongoing behavioral health intervention plan, a mental health clinician addresses tobacco use. However, this session appears to be relatively brief.
· When the session does not exceed the time limit of 10 minutes and mainly discusses cessation of tobacco use, the CPT 99406 should be allotted to this session.
CPT 99407: In-Depth Counseling Services
As per the description of CPT code 99407, it is used for counseling tobacco cessation at a higher intensity level (greater than 10 minutes). This is a more comprehensive session supporting more complex behavioral issues.
Who can bill 99407?
Like 99406, this code can only be billed by licensed providers like physicians, psychologists, and even nurse practitioners who provide detailed counseling regarding tobacco cessation.
Commonly described situations for 99407
· A clinician spends twenty minutes tailoring a personalized quit plan for a patient whom they have already assessed, managing withdrawal symptoms, mid-loop meals, and regularly scheduled admin intervals.
· A behavioral health specialist guides a patient through a targeted counseling session that incorporates motivational techniques and coping methods for tobacco dependence.
· After delivering detailed options for pharmacotherapeutic intervention alongside support for behavioral change, the session closes with a primary care provider refocusing on assessment of patient compliance.
· There is reasonable justification to apply 99407 if the counseling session lasts over 10 minutes and additional depth would be required to deepen engagement.
Comparison: CPT 99406 vs 99407
| Code | Time Spent | Session Type | Use Case |
| 99406 | 3–10 minutes | Intermediate Counseling | Quick tobacco quit conversation |
| 99407 | >10 minutes | Intensive Counseling | Deep support with a structured plan |
One code can be billed per session. Using both codes on the same day or the same session bill can lead to your bill to denied.
Tending To Documentation and Billing Needs
In order to bill either procedure accurately, documentation must contain the following information:
· Time spent. For example, 9 minutes spent counseling on smoking cessation.
· Patient tobacco status
· Specific strategies for cessation were discussed
· Approval to counsel and interest in cessation
· Link the CPT code for tobacco cessation to diagnosis codes like Z71.6 (tobacco use counseling) or F17.200 (nicotine dependence).
· Notes that are kept must demonstrate medical necessity. Without this, the claim could be rejected.
Common Errors to Ensure Smooth Claims Processing
While using smoking cessation CPT codes, mistakes may cause a delay or denial of claims. Avoid the following errors:
· Not having sufficient documentation to support the use of smoking cessation CPT codes 99406 or 99407.
· Failing to note the time spent on counseling sessions
· Claiming without verifying tobacco use
· Not linking the proper ICD-10 diagnosis code
· Re-check insurer-specific guidelines, since some may instruct other requirements like pre-authorization or specific modifiers.
Proactive Steps to Take for Claim Denial Reduction
In order to reduce billing challenges with tobacco cessation CPT codes, make these adjustments:
· Check the session time and ensure it is properly recorded
· Confirm tobacco use and willingness to quit
· Use appropriate diagnosis codes such as Z71.6
· Ensure notes from previous appointments are not copied and pasted
· When in doubt, consult payer policies for changes to compliance rules
Telehealth and Tobacco Cessation Codes
Can providers use CPT codes 99406 and 99407 when service is provided via telehealth?
Yes, many payers consider telehealth services also if:
· The time of the session meets the standard time and documentation requirements
· Proper diagnosis codes and modifiers are used
· The state and place of the service are mentioned as telehealth
· Mention who was given the online session, and also include the patient’s history
Modifiers and Tobacco Treatment Counseling Codes
Modifiers might be necessary for billing 99406 and 99407, particularly in regard to telehealth services or same-day appointments.
· When submitting telehealth claims, make sure to append modifier 95 for audio/video sessions. In addition, facility claims might require exclusionary position or POS codes (e.g., 02 for telehealth).
· If other services are being billed on the same date, like E/M, confirm with the payer that modifier 25 is required or that separate services were provided.
· When considering Does CPT code 99406 need a modifier? the answer depends on context. Like always, check your specific payer policies.
Final Considerations
Using CPT code for tobacco cessation like 99406 and 99407, aids in revenue increase and helps patients smoke less. The right code should be selected based on counseling time, and ensure notes are made based on session depth.
Confirm that the claims and the documentation align with the requirements set by the payer, and the medical necessity is justified.
Related Reading: For providers working with group or family settings, understanding how to bill multiple-family group psychotherapy sessions is equally important — learn more in our guide on 90849 CPT Code: Billing for Multiple-Family Group Psychotherapy.
Bonus Tips
Choosing a good billing business helps simplify coding and cut down on denials to improve cash flow. A trustworthy billing partner will guarantee submission of accurate and timely smoking cessation CPT code claims so providers can direct their focus on helping patients stop tobacco use.
