CPT Code 99407: Tobacco Cessation, >10 Min

• CPT Codes
• 99407

CPT Code 99407: Tobacco Cessation, >10 Min

CPT code 99407 for intensive smoking and tobacco cessation counseling over 10 minutes. Billing guidance for behavioral health providers.

Quick Reference

Code

99407

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

8 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 99407: Tobacco Cessation Counseling, Greater Than 10 Minutes

CPT code 99407 covers intensive smoking and tobacco use cessation counseling delivered face-to-face for greater than 10 minutes. This code represents the extended version of tobacco cessation counseling, providing higher reimbursement than the brief counseling captured by CPT 99406. In behavioral health settings, where tobacco use prevalence is dramatically elevated compared to the general population, intensive cessation counseling addresses a critical clinical need.

Research consistently shows that longer cessation counseling sessions produce higher quit rates. For behavioral health providers, investing the time required for intensive counseling and capturing that time with 99407 supports both better patient outcomes and appropriate compensation for the clinical effort involved.

Definition and Purpose

CPT code 99407 describes a smoking and tobacco use cessation counseling visit of intensive duration, greater than 10 minutes. The code is structured to capture the additional clinical effort required when cessation counseling goes beyond a brief intervention.

Time threshold. The defining feature of 99407 is its time requirement: the face-to-face cessation counseling must exceed 10 minutes. There is no defined upper time limit for 99407, though the counseling must remain focused on tobacco cessation. If the session involves other clinical activities beyond cessation counseling, only the time spent specifically on cessation topics counts toward the 99407 time threshold.

Clinical activities. Intensive cessation counseling under 99407 typically involves a deeper engagement than the brief intervention covered by 99406. Activities commonly include comprehensive assessment of tobacco use history, including age of initiation, prior quit attempts, methods used, and reasons for relapse. It also covers detailed exploration of barriers to quitting, such as social triggers, stress management, withdrawal concerns, and co-occurring psychiatric symptoms. Motivational interviewing techniques to build and strengthen commitment to change are central to 99407 sessions. Development of a personalized quit plan with specific strategies, quit dates, and contingency plans is also part of the service, along with detailed pharmacotherapy counseling about cessation medications and referral to adjunct cessation resources.

Standalone or combined. Like 99406, CPT 99407 can be reported as a standalone service or alongside other services such as E&M visits, psychotherapy, or substance use counseling provided on the same date.

When to Use in Behavioral Health

Intensive tobacco cessation counseling is particularly valuable in behavioral health contexts where patients face compounding challenges to quitting.

Dual diagnosis treatment programs. Patients with co-occurring mental health and substance use disorders often have deeply entrenched tobacco use patterns. These patients benefit from extended cessation counseling that addresses the intersection of tobacco use with their other conditions, including the role of nicotine in self-medication, interactions between psychiatric medications and smoking, and the relationship between tobacco cessation and recovery from other substances.

Inpatient and residential transitions. When patients in smoke-free residential treatment programs are preparing for discharge, intensive cessation counseling helps them develop strategies for maintaining abstinence from tobacco in less structured environments. These conversations frequently exceed 10 minutes and are well suited to 99407.

Pharmacotherapy initiation. When a provider is recommending or prescribing cessation pharmacotherapy (nicotine replacement therapy, bupropion, or varenicline), the discussion often requires more than 10 minutes to cover medication options, dosing schedules, side effects, contraindications (particularly in patients with psychiatric conditions), and integration with the patient’s existing medication regimen.

Relapse prevention planning. Patients who have recently quit or who have a history of multiple relapse episodes benefit from extended counseling focused on identifying high-risk situations, developing coping strategies, and building support systems. This type of counseling frequently exceeds the 10-minute threshold.

Pre-contemplation and contemplation stage patients. Patients who are not yet ready to quit require more extensive motivational interviewing to explore ambivalence, build discrepancy between current behavior and personal values, and support movement toward a decision to quit. These conversations are inherently longer and more nuanced than brief advice to stop smoking.

Documentation Requirements

Documentation for 99407 must clearly establish that the cessation counseling exceeded 10 minutes and that the content focused on tobacco use cessation.

Time documentation. Record the specific duration of cessation counseling. For example: “Provided face-to-face tobacco cessation counseling for 18 minutes.” If the counseling is part of a larger visit, clearly distinguish the cessation counseling time from time spent on other clinical activities.

Content documentation. Describe the specific cessation counseling activities performed during the session. Document topics discussed, assessments conducted, patient responses, readiness to change, quit plan elements, pharmacotherapy discussions, and referrals made. Vague notes such as “cessation counseling provided” are insufficient.

Tobacco use assessment. Document the patient’s current tobacco use status, including the type and quantity of tobacco products used, nicotine dependence severity, and any changes since the last assessment.

Patient-specific factors. In behavioral health settings, document how the patient’s psychiatric or substance use conditions relate to their tobacco use and cessation planning. This contextualizes the medical necessity for intensive counseling and supports the clinical rationale for the extended duration.

Separation from other services. If 99407 is billed on the same date as an E&M visit, psychotherapy, or other service, clearly delineate the cessation counseling as a distinct intervention. Use separate sections in your note or clearly label the cessation counseling portion.

Billing and Reimbursement

As of March 2026, Medicare reimburses CPT 99407 at a higher rate than 99406, reflecting the additional time and clinical effort involved. Exact rates vary by geographic region.

Medicare coverage. Medicare Part B covers 99407 under the same preventive benefit as 99406. Two cessation attempts per 12-month period, with up to four sessions per attempt, for a maximum of eight sessions annually. No patient copay, coinsurance, or deductible applies when billed with an appropriate tobacco use diagnosis code. Sessions using 99406 and 99407 both count toward the same combined annual limit.

Diagnosis coding. Report ICD-10 codes from the F17 category (nicotine dependence) as the primary diagnosis. Use the specific code that matches the type of tobacco product and the patient’s dependence status. Z87.891 (personal history of nicotine dependence) may be used for patients who have quit but are receiving relapse prevention counseling.

Commercial payer coverage. Most commercial plans cover tobacco cessation counseling as a required preventive service under the Affordable Care Act. Coverage details, including session limits and cost-sharing waivers, vary by plan. Some plans offer more generous benefits than Medicare, including coverage for additional sessions or extended counseling programs.

Same-day billing. When reporting 99407 alongside an E&M service, append modifier 25 to the E&M code. The cessation counseling must be documented as a separate, distinct service. Do not report both 99406 and 99407 for the same encounter — select the code that matches the total cessation counseling duration.

Common Modifiers

Modifier 25 is applied to the accompanying E&M code (not to 99407) when both are reported on the same date. This signals that the E&M service is significant and separately identifiable.

Modifier 33 designates the service as preventive care. Some payers require this modifier to correctly process 99407 as a covered preventive service and waive patient cost-sharing.

Modifier 95 indicates synchronous telemedicine delivery. Many payers accept 99407 for telehealth cessation counseling. Confirm current telehealth policies with each payer.

Modifier SC may be required by certain Medicaid programs to indicate medical necessity of the service.

Do not use modifier 52 (reduced services) if the counseling is close to the 10-minute threshold. If the counseling duration is 10 minutes or less, report 99406 instead. CPT 99407 requires that counseling exceed 10 minutes.

Compliance Considerations

Compliance practices for 99407 parallel those for 99406, with additional attention to time documentation given the higher reimbursement rate.

Accurate time differentiation. The distinction between 99406 and 99407 rests entirely on whether cessation counseling exceeds 10 minutes. Document time precisely. Consistently billing 99407 when counseling is borderline (for example, always reporting exactly 11 minutes) may attract payer scrutiny. Time documentation should reflect the actual clinical encounter.

Session count tracking. Implement a tracking system to monitor the number of cessation sessions provided to each Medicare beneficiary within a 12-month period. Exceeding the eight-session annual maximum will result in denials, and the provider may be liable for any amounts collected from the patient.

Clinical appropriateness. While intensive cessation counseling is clinically valuable, not every tobacco-using patient requires a session exceeding 10 minutes at every visit. Use clinical judgment to determine the appropriate level of counseling for each encounter and code accordingly.

Coordination with cessation programs. If your organization offers a structured tobacco cessation program, ensure that individual counseling sessions billed under 99407 are coordinated with program activities and that the same services are not billed under multiple codes.

Documentation audits. Periodically audit 99407 claims to verify that documentation supports the reported duration, content is focused on cessation, and the service is distinct from other services provided on the same date.

Related Billing Codes

• 99355
• 99396
• 99406
• 99408
• 99409
• 99484

Common questions

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