Tobacco cessation counseling

Applies to:

All plans

Clinical Practice Guideline

Tobacco cessation counseling billing

Priority Health will reimburse, fee for service, for tobacco cessation counseling codes. Reimbursement is available to primary care and specialty physicians.

Documentation requirements

  • Document the exact time spent with the patient involving smoking cessation counseling. 
  • Document what was discussed during this counseling session (plans to decrease smoking and/or steps to quit smoking)  
  • Documentation must support the code being billed.

Examples of inadequate documentation

These examples lack a) the exact time and b) what was discussed.

  • "Spent greater than 3 minutes counseling the patient on smoking."
  • "Spent between 3 to 10 minutes counseling the patient on smoking."
  • "Spent over 10 minutes counseling the patient on smoking."

Reimbursement rates

The reimbursement rates for these codes are listed in our standard fee schedules for your contract. See schedules.

Billable codes

The CPT and HCPCS manuals define billing and coding requirements for tobacco counseling codes. Codes should be billed with the appropriate ICD10 code identifying tobacco use.

These codes can be billed by either the physician or a qualified health professional.

Code Description Reimbursement
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Payable as a preventive benefit; no member copayment or deductible
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes Payable as a preventive benefit; no member copayment or deductible
4000F Tobacco use cessation intervention, counseling (COPD, CAP, CAD, Asthma) (DM) (PV) CMS CPTII report only code; no reimbursement
4001F Tobacco use cessation intervention, pharmacologic therapy (COPD, CAD, CAP, PV, Asthma) (DM) (PV) CMS CPTII report only code; no reimbursement
4004F Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) CMS CPTII report only code; no reimbursement