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CPT code 99403: Preventive counseling, individual, about 45 minutes2026 Medicare rate & RVUs

Individual preventive counseling for an approximately 45-minute session, distinguished from shorter or longer individual services and group counseling.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99403

Preventive counseling, individual, about 45 minutes

Office or facility?

Work RVUs
1.46
Total RVUs
1.86
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99403 →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 99403 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 99403 covers

99403 is the individual preventive counseling option associated with an approximately 45-minute session. It distinguishes individual counseling from group preventive counseling and is selected by approximate session duration within the individual series. Codes 99401 and 99402 represent shorter approximate sessions, while 99404 represents a longer approximate session. The counseling is preventive rather than a smoking-specific behavioral intervention such as 99406.

For Medicare, 99403 has physician fee schedule status N, which means Medicare does not cover the service. It is a CPT Category I preventive counseling code. The approximate 45-minute duration separates it from the shorter individual options, 99401 and 99402, and the longer individual option, 99404. Group preventive counseling is represented by 99411 and 99412.

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 99403 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

99403 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

99403 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
99403 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 99403 rate is calculated

Each of 99403’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 · 99403

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.46

1.46 RVUs× 1.000 GPCI

Practice expense1.10

1.10 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

2.6400

Conversion factor

$33.4009

Medicare rate

$88.18

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

Payment rules and modifiers for 99403

99403 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 · 99403

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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99403 isn’t priced in this setting.

99403 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99403

    Preventive counseling, individual, about 45 minutes1.46 wRVU

    Not priced

  • 99402

    Preventive counseling, approximately 30 minutes0.98 wRVU

    Not priced

  • 99404

    Preventive counseling, individual, approximately 60 minutes1.95 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 are individual preventive counseling services; 99402 is for a shorter approximate session than 99403.
99404Preventive counselingIndividual, approximately 60 minutes
Both are individual preventive counseling services; 99404 is for a longer approximate session than 99403.
99411Group counselingApproximately 30 minutes
99411 is for group preventive counseling. 99403 is the individual counseling option.
99406Smoking cessationMore than 3 through 10 minutes
99406 is a time-based behavioral intervention for smoking; 99403 is individual preventive counseling for an approximately 45-minute session.

Codes related to 99403

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

Codes related to 99403
CodeHow it relatesNational office range
Same family
99401Preventive counseling, individual, approximately 15 minutesIndividual preventive counseling for a shorter approximate session.No office rate
99402Preventive counseling, approximately 30 minutesIndividual preventive counseling for a shorter approximate session.No office rate
99404Preventive counseling, individual, approximately 60 minutesIndividual preventive counseling for a longer approximate session.No office rate
Used instead
99411Group counseling, approximately 30 minutesGroup preventive counseling rather than individual counseling.No office rate
99412Group preventive counseling, approximately 60 minutesGroup preventive counseling rather than individual counseling.No office rate

99403 billing questions

How does 99403 differ from 99402 or 99404?

These are individual preventive counseling options distinguished by approximate session duration. 99403 is for about 45 minutes, between the shorter 99402 and longer 99404 services.

Can 99403 be used for counseling delivered to a group?

99403 identifies individual preventive counseling. Codes 99411 and 99412 identify group preventive counseling.

Does Medicare cover 99403?

No. Its Medicare physician fee schedule status is N, meaning Medicare does not cover the service.

How does 99403 differ from 99406?

99403 is individual preventive counseling for an approximately 45-minute session. 99406 is a time-based behavioral intervention for smoking.

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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