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See a sample rate comparisonCPT 99406 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Smoking And Tobacco Use Cessat, Smoking And Tobacco Use Cessation Counseling Visit Intermediate Greater Than 3 Minutes Up To 10 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.36 national non-facility rate (2026) · View Medicare rates for 99406 |
| Medicaid Fee Schedule | $12.05 median of the 8 states in the free preview · View Medicaid rates for 99406 |
National average reimbursement for CPT 99406 by major payers:
$16.97
$17.62
$17.89
$30.31
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CPT 99406
5 of 25 sample ratesHigher to lower in this preview
Neelima Narreddy
Wheatland Inpatient Services
$50.15Published rateCortland Vis
University Physicians Incorporated
$28.55Published rateKale Meeks
Southwest Volusia Healthcare Corporation
$17.14Published rateLaura Soler
Jerome Lee Sang M.D. P.A
$12.42Published rateDr. George S Tellam, Ankle & Foot Associates
George S Tellam Dpm
$7.57Published rate
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See a sample payer proposalCPT 99406 vs. Other Preventive Medicine Services Codes
The CPT 99406 code is part of the Evaluation and Management services used for Preventive Medicine Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99406 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99406-CPT | Low | Smoking And Tobacco Use Cessat, Smoking And Tobacco Use Cessation Counseling Visit Intermediate Greater Than 3 Minutes Up To 10 Minutes |
| 99407-CPT | Low | Smoking And Tobacco Use Cessation Counseling Visit Intensive, Greather Than 10 Minutes Medicaid Level Of Care 6, As Defined By Each State |
| 99408-CPT | Low | Alcohol Andor Substance (Othe, Alcohol Andor Substance (Other Than Tobacco) Abuse Structured Screening (E.G. Audit Dast) And Brief Intervention (Sbi) Services 15 To 30 Minutes |
| 99409-CPT | Low | Alcohol Andor Substance (Othe, Alcohol Andor Substance (Other Than Tobacco) Abuse Structured Screening (E.G. Audit Dast) And Brief Intervention (Sbi) Services Greater Than 30 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99406 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
The CPT 99406 code is part of the Evaluation and Management services used for Preventive Medicine Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements. The CPT 99406 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements. For specific reimbursement rates and exact documentation guidelines tailored to your unique situation, payer, and geographic location, it's recommended to consult a tool like Payerprice, which offers a fee schedule lookup with CPT code and specific location.