CPT code 99404: Preventive counseling, individual, approximately 60 minutes2026 Medicare rate & RVUs in Massachusetts
Individual preventive counseling for risk reduction, reported when a clinician provides approximately 60 minutes of counseling to one patient.
CMS doesn’t publish an office rate for 99404 in Massachusetts.
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 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 in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
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
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
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.
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
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