99406

Intermediate Smoking and Tobacco Use Cessation Counseling (3-10 minutes)

CPT 99406 represents an intermediate-level behavioral intervention focused on smoking and tobacco use cessation. This specific procedural code is utilized when a physician or other qualified healthcare professional provides face-to-face counseling for a duration that exceeds three minutes but does not exceed ten minutes. The intervention is aimed at helping patients overcome nicotine addiction and the habitual behaviors associated with tobacco consumption. During the session, the clinician evaluates the patient's current tobacco use status, their level of nicotine dependence, and their readiness to make a quit attempt using the '5 As' framework: Ask, Advise, Assess, Assist, and Arrange. The clinician provides specific advice on why quitting is necessary based on the patient's clinical profile, assesses their willingness to set a quit date, and assists the patient by discussing pharmacological options such as nicotine replacement therapy (NRT), varenicline, or bupropion. Furthermore, the counseling session involves identifying environmental triggers, social pressures, and psychological stressors that contribute to continued tobacco use. Strategies for managing withdrawal symptoms and stress without tobacco are also discussed. For billing purposes, the time spent must be purely dedicated to cessation counseling and must be documented in the medical record. This service is often performed in conjunction with an Evaluation and Management (E/M) service. When provided on the same day as an E/M visit, the cessation counseling must be distinct and documented as such. The E/M code must be appended with modifier 25 to indicate it was a significant, separately identifiable service beyond the typical counseling provided during an office visit. The objective of 99406 is to reduce long-term morbidity and mortality associated with tobacco use by providing accessible, brief interventions during routine clinical encounters.

Clinical Indications

  • Current cigarette smoking with nicotine dependence
  • Use of electronic nicotine delivery systems (vaping)
  • Use of smokeless tobacco products (chewing tobacco, snuff)
  • Pregnancy with concurrent tobacco use
  • Preoperative optimization to reduce surgical complications
  • Patients with chronic conditions exacerbated by tobacco (COPD, asthma, CAD)
  • Patients who have expressed a desire to attempt tobacco cessation
  • Patients at risk for tobacco-related cancers

Procedure Steps

  1. Identify and document the patient's current tobacco use status and history
  2. Advise the patient to quit tobacco use with a clear, strong, and personalized message
  3. Assess the patient's readiness to quit (e.g., using the Stages of Change model)
  4. Identify triggers and barriers that have hindered past quit attempts
  5. Discuss various cessation methods, including behavioral modifications and pharmacotherapy options
  6. Collaborate with the patient to set a specific quit date or reduction goal
  7. Provide resources for additional support (e.g., quitlines, support groups)
  8. Document the total time spent in face-to-face counseling (must be >3 to 10 minutes)

Coding Guidelines

  • The duration of the counseling must be greater than 3 minutes but no more than 10 minutes
  • For counseling sessions lasting more than 10 minutes, use code 99407
  • If performed on the same day as an E/M service (e.g., 99213), append modifier 25 to the E/M code
  • Documentation must explicitly state the time spent and the specific topics discussed during counseling
  • Medicare covers up to two cessation attempts per year, with each attempt allowing up to four sessions (total of 8 sessions per 12 months)
  • Do not report 99406 in conjunction with preventive medicine individual counseling codes 99401-99404
  • The counseling may be provided to patients with or without signs or symptoms of tobacco-related disease

Associated ICD-10 Codes