CPT code 99401: Preventive counseling, individual, approximately 15 minutes2026 Medicare rate & RVUs in Illinois
Reports an individual preventive counseling service of approximately 15 minutes focused on health risks and behavior change.
CMS doesn’t publish an office rate for 99401 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | Unavailable |
| East St. Louis, IL | Unavailable | Unavailable |
| Rest of Illinois | Unavailable | Unavailable |
| Suburban Chicago, IL | Unavailable | Unavailable |
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
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
—
99401 isn’t priced in this setting.
99401 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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