CPT code 99402: Preventive counseling, approximately 30 minutes2026 Medicare rate & RVUs in Maryland
Individual preventive counseling at the approximately 30-minute level for a patient receiving risk-reduction or health behavior guidance.
CMS doesn’t publish an office rate for 99402 in Maryland.
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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What 99402 covers
99402 identifies individual preventive counseling, commonly focused on reducing health risks and supporting behavior change. A physician or other qualified health professional counsels one patient; examples may include nutrition, physical activity, or tobacco-related risk reduction. Its approximately 30-minute level distinguishes it from shorter and longer individual counseling codes. Group counseling is reported with different codes in the preventive counseling family.
Medicare does not cover 99402; its physician fee schedule status is N. This CPT Category I service represents an approximately 30-minute individual counseling level. For individual preventive counseling, 99401 represents approximately 15 minutes, 99403 approximately 45 minutes, and 99404 approximately 60 minutes. Group counseling codes 99411 and 99412 use a group format. Billing teams should match the documented service to the individual format and applicable approximate time level.
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 99402 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | Unavailable |
| Rest of Maryland | Unavailable | Unavailable |
| Washington, DC area | Unavailable | Unavailable |
How the 99402 rate is calculated
Each of 99402’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 · 99402
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense0.90
0.90 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
1.9400
Conversion factor
$33.4009
Medicare rate
$64.80
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99402
99402 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 · 99402
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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99402 isn’t priced in this setting.
99402 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99401Preventive counselingIndividual, approximately 15 minutes
- 99401 is the shorter individual preventive counseling level, approximately 15 minutes; 99402 represents approximately 30 minutes.
- 99403Preventive counselingIndividual, about 45 minutes
- 99403 represents approximately 45 minutes of individual preventive counseling, compared with approximately 30 minutes for 99402.
- 99411Group counselingApproximately 30 minutes
- 99411 is for preventive counseling delivered to a group. Use 99402 for individual counseling.
99402 billing questions
When should 99402 be selected instead of 99401 or 99403?
Use 99402 for individual preventive counseling at the approximately 30-minute level. The neighboring codes represent shorter or longer individual counseling time levels.
Is 99402 for individual or group counseling?
It identifies counseling for one patient. Codes 99411 and 99412 are for group preventive counseling.
Does Medicare cover 99402?
No. Medicare physician fee schedule status N identifies the service as not covered by Medicare.
Which time level does 99402 represent?
99402 represents approximately 30 minutes of individual preventive counseling.
Who provides the counseling represented by 99402?
A physician or other qualified health professional counsels one patient.
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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