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

CMS doesn’t publish an office rate for 99403 in Texas.

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

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 in Texas

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

8 of 8 payment localities

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.

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.

99403 compared with similar codes

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.

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