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

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

CMS RVU26DEffective Oct 1, 2026One payment locality

CMS doesn’t publish a rate for 99404 in South Carolina.

Separate payment rules applyOffice (non-facility)
Separate payment rules applyHospital or facility

Check a contract rate as a % of Medicare · 99404 nationwide

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

We’ll open 99404 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in South Carolina
  2. What 99404 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. 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.

How South Carolina compares for 99404

99404 in South Carolina vs other payment areas
  1. South Carolina · this pageUnavailable
  2. Los Angeles, CA · CaliforniaUnavailable
  3. Washington, DC area · District of ColumbiaUnavailable
  4. Miami, FL · FloridaUnavailable
  5. Chicago, IL · IllinoisUnavailable
  6. Manhattan, NY · New YorkUnavailable
  7. Alaska · AlaskaUnavailable

Other areas in South Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

99404 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama——
ArkansasArkansas——
ArizonaArizona——
Bakersfield, CACalifornia——
Chico, CACalifornia——
El Centro, CACalifornia——
Fresno, CACalifornia——
Hanford, CACalifornia——

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

See 99404 in every payment locality

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

—

99404 isn’t priced in this setting.

Codes related to 99404

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

Codes related to 99404
CodeHow it relatesOffice range, South Carolina
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

How 99404 has changed in South Carolina

99404 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Separate payment rules applySeparate payment rules applyRVU26D
2026-07-01Separate payment rules applySeparate payment rules applyRVU26C
2026-04-01Separate payment rules applySeparate payment rules applyRVU26B
2026-01-01Separate payment rules applySeparate payment rules applyRVU26A
2025-10-01Separate payment rules applySeparate payment rules applyRVU25D
2025-07-01Separate payment rules applySeparate payment rules applyRVU25C
2025-04-01Separate payment rules applySeparate payment rules applyRVU25B
2025-01-01Separate payment rules applySeparate payment rules applyRVU25A
2024-10-01Separate payment rules applySeparate payment rules applyRVU24D
2024-07-01Separate payment rules applySeparate payment rules applyRVU24C
2024-04-01Separate payment rules applySeparate payment rules applyRVU24B
2024-03-09Separate payment rules applySeparate payment rules applyRVU24AR
2024-01-01Separate payment rules applySeparate payment rules applyRVU24A
2023-10-01Separate payment rules applySeparate payment rules applyRVU23D
2023-07-01Separate payment rules applySeparate payment rules applyRVU23C
2023-04-01Separate payment rules applySeparate payment rules applyRVU23B
2023-01-01Separate payment rules applySeparate payment rules applyRVU23A
2022-10-01Separate payment rules applySeparate payment rules applyRVU22D
2022-07-01Separate payment rules applySeparate payment rules applyRVU22C
2022-04-01Separate payment rules applySeparate payment rules applyRVU22B
2022-01-01Separate payment rules applySeparate payment rules applyRVU22A
2021-10-01Separate payment rules applySeparate payment rules applyRVU21D
2021-07-01Separate payment rules applySeparate payment rules applyRVU21C
2021-04-01Separate payment rules applySeparate payment rules applyRVU21B
2021-01-01Separate payment rules applySeparate payment rules applyRVU21A
2020-10-01Separate payment rules applySeparate payment rules applyRVU20D
2020-07-01Separate payment rules applySeparate payment rules applyRVU20C
2020-04-01Separate payment rules applySeparate payment rules applyRVU20B
2020-01-01Separate payment rules applySeparate payment rules applyRVU20A
2019-10-01Separate payment rules applySeparate payment rules applyRVU19D
2019-07-01Separate payment rules applySeparate payment rules applyRVU19C
2019-04-01Separate payment rules applySeparate payment rules applyRVU19B
2019-01-01Separate payment rules applySeparate payment rules applyRVU19A
2018-10-01Separate payment rules applySeparate payment rules applyRVU18D
2018-07-01Separate payment rules applySeparate payment rules applyRVU18C
2018-04-01Separate payment rules applySeparate payment rules applyRVU18B
2018-01-01Separate payment rules applySeparate payment rules applyRVU18AR1
2017-10-01Separate payment rules applySeparate payment rules applyRVU17D
2017-07-01Separate payment rules applySeparate payment rules applyRVU17C
2017-04-01Separate payment rules applySeparate payment rules applyRVU17B
2017-01-01Separate payment rules applySeparate payment rules applyRVU17A
2016-10-01Separate payment rules applySeparate payment rules applyRVU16D
2016-07-01Separate payment rules applySeparate payment rules applyRVU16C
2016-04-01Separate payment rules applySeparate payment rules applyRVU16B
2016-01-01Separate payment rules applySeparate payment rules applyRVU16A
2015-10-01Separate payment rules applySeparate payment rules applyRVU15D
2015-07-01Separate payment rules applySeparate payment rules applyRVU15C
2015-04-01Separate payment rules applySeparate payment rules applyRVU15B
2015-01-01Separate payment rules applySeparate payment rules applyRVU15A
2014-10-01Separate payment rules applySeparate payment rules applyRVU14D
2014-07-01Separate payment rules applySeparate payment rules applyRVU14C
2014-04-01Separate payment rules applySeparate payment rules applyRVU14B
2014-01-01Separate payment rules applySeparate payment rules applyRVU14A
2013-10-01Separate payment rules applySeparate payment rules applyRVU13D
2013-07-01Separate payment rules applySeparate payment rules applyRVU13C
2013-04-01Separate payment rules applySeparate payment rules applyRVU13B
2013-01-01Separate payment rules applySeparate payment rules applyRVU13AR

Price 99404 for an earlier date of service

Where the South Carolina rate applies

South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Abbeville
  • Abney Crossroads
  • Adams Run
  • Aiken
  • Alcolu
  • Allendale
  • Anderson
  • Andrews

Browse all communities in South Carolina

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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