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CPT code 99401: Preventive counseling, individual, approximately 15 minutes2026 Medicare rate & RVUs

Reports an individual preventive counseling service of approximately 15 minutes focused on health risks and behavior change.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99401

Preventive counseling, individual, approximately 15 minutes

Office or facility?

Work RVUs
0.48
Total RVUs
0.62
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99401 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99401 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99401 covers

99401 identifies an individual preventive counseling service focused on health risks and reducing risk through behavior change. A physician or other qualified health professional may use it to discuss topics such as nutrition, physical activity, tobacco use, sexual health, or injury prevention with one patient. It distinguishes individual counseling from group preventive counseling and from longer individual counseling services. These discussions address prevention and risk reduction.

Medicare lists 99401 as not covered and assigns physician fee schedule status N. The code represents an approximately 15-minute individual session; 99402, 99403, and 99404 identify longer individual counseling intervals, while 99411 and 99412 are group preventive counseling codes. Select among the individual codes according to the applicable time range, and distinguish them from group services by format.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99401 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99401 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

99401 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99401 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99401 rate is calculated

Each of 99401’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 99401

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.48

0.48 RVUs× 1.000 GPCI

Practice expense0.68

0.68 RVUs× 1.000 GPCI

Malpractice0.03

0.03 RVUs× 1.000 GPCI

Adjusted RVUs

1.1900

Conversion factor

$33.4009

Medicare rate

$39.75

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99401

99401 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 99401

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

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99401 isn’t priced in this setting.

99401 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99401

    Preventive counseling, individual, approximately 15 minutes0.48 wRVU

    Not priced

  • 99402

    Preventive counseling, approximately 30 minutes0.98 wRVU

    Not priced

  • 99411

    Group counseling, approximately 30 minutes0.15 wRVU

    Not priced

  • 99406

    Smoking cessation, more than 3 through 10 minutes0.24 wRVU

    $15.36

How to choose

99402Preventive counselingApproximately 30 minutes
Both describe individual preventive counseling; 99402 represents a longer time range than 99401.
99411Group counselingApproximately 30 minutes
99401 is individual counseling. 99411 is for preventive counseling delivered to a group.
99406Smoking cessationMore than 3 through 10 minutes
99406 identifies tobacco-cessation counseling by time range; 99401 describes general individual preventive counseling.

Codes related to 99401

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 99401
CodeHow it relatesNational office range
Same family
99402Preventive counseling, approximately 30 minutesIndividual preventive counseling for a longer time range.No office rate
99403Preventive counseling, individual, about 45 minutesIndividual preventive counseling for a longer time range.No office rate
99404Preventive counseling, individual, approximately 60 minutesIndividual preventive counseling for the longest time range in this series.No office rate
Used instead
99411Group counseling, approximately 30 minutesGroup preventive counseling for a shorter time range.No office rate
99412Group preventive counseling, approximately 60 minutesGroup preventive counseling for a longer time range.No office rate

99401 billing questions

How do I distinguish 99401 from 99402?

99401 represents approximately 15 minutes of individual preventive counseling. 99402 represents the longer individual counseling interval.

Can 99401 be used for group counseling?

No. 99401 is for individual counseling; 99411 and 99412 are group preventive counseling codes.

Does Medicare cover 99401?

No. Medicare lists the code as not covered and assigns physician fee schedule status N.

Is 99401 the code for tobacco-cessation counseling?

99401 describes general individual preventive counseling. Codes 99406 and 99407 identify tobacco-cessation counseling by time range.

How do I choose among 99401, 99402, 99403, and 99404?

Choose the individual preventive counseling code that corresponds to the applicable time range; 99401 represents approximately 15 minutes, and the other codes represent longer intervals.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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