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CPT code 99404: Preventive counseling, individual, approximately 60 minutes2026 Medicare rate & RVUs

Individual preventive counseling for risk reduction, reported when a clinician provides approximately 60 minutes of counseling to one patient.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99404

Preventive counseling, individual, approximately 60 minutes

Office or facility?

Work RVUs
1.95
Total RVUs
2.49
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99404 →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 99404 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 99404 covers

This service is individual preventive counseling intended to support prevention and reduction of health risks. It represents an approximately 60-minute counseling session, distinct from the shorter individual preventive counseling services represented by 99401, 99402, and 99403. The distinction from codes 99411 and 99412 is the individual format rather than group preventive counseling. Codes 99406 and 99407 are nearby options for behavioral counseling focused on smoking, rather than general individual preventive counseling.

Medicare lists 99404 with physician fee schedule status N, meaning Medicare does not cover the service under this code. The service is reported as an individual preventive counseling session of approximately 60 minutes; its time distinction separates it from the shorter individual counseling codes in the same family.

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 99404 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

99404 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

99404 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
99404 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 99404 rate is calculated

Each of 99404’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 · 99404

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.95

1.95 RVUs× 1.000 GPCI

Practice expense1.32

1.32 RVUs× 1.000 GPCI

Malpractice0.12

0.12 RVUs× 1.000 GPCI

Adjusted RVUs

3.3900

Conversion factor

$33.4009

Medicare rate

$113.23

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

Payment rules and modifiers for 99404

99404 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 · 99404

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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99404 isn’t priced in this setting.

99404 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99404

    Preventive counseling, individual, approximately 60 minutes1.95 wRVU

    Not priced

  • 99403

    Preventive counseling, individual, about 45 minutes1.46 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

  • 99407

    Smoking cessation, more than 10 minutes0.5 wRVU

    $29.06

How to choose

99403Preventive counselingIndividual, about 45 minutes
Both describe individual preventive counseling; 99403 is for approximately 45 minutes, while 99404 is for approximately 60 minutes.
99411Group counselingApproximately 30 minutes
99411 describes group preventive counseling. 99404 describes an individual session.
99406Smoking cessationMore than 3 through 10 minutes
99406 is behavioral counseling focused on smoking in a 3-to-10-minute range; 99404 is general individual preventive counseling of approximately 60 minutes.
99407Smoking cessationMore than 10 minutes
99407 is behavioral counseling focused on smoking lasting more than 10 minutes. 99404 is general individual preventive counseling of approximately 60 minutes.

Codes related to 99404

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

Codes related to 99404
CodeHow it relatesNational office range
Same family
99401Preventive counseling, individual, approximately 15 minutesShorter individual preventive counseling sibling, approximately 15 minutes.No office rate
99402Preventive counseling, approximately 30 minutesShorter individual preventive counseling sibling, approximately 30 minutes.No office rate
99403Preventive counseling, individual, about 45 minutesShorter individual preventive counseling sibling, approximately 45 minutes.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

99404 billing questions

When should 99404 be chosen instead of 99403?

Use 99404 for individual preventive counseling of approximately 60 minutes. Code 99403 represents the approximately 45-minute sibling service.

Can 99404 be used for group counseling?

99404 describes individual counseling. Codes 99411 and 99412 describe group preventive counseling.

Does Medicare cover 99404?

No. Medicare lists the physician fee schedule status as N, meaning the service is not covered under this code.

How many units should be reported?

99404 identifies an individual preventive counseling service of approximately 60 minutes. It is distinguished from the shorter services by duration, not by a drug dose or supply quantity.

Is 99404 the code for smoking counseling?

No. 99404 is for general individual preventive counseling. Codes 99406 and 99407 describe behavioral counseling focused on 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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