Billing code 99406: Smoking cessationMedicare rate & RVUs in Delaware
Report 99406 for an individual smoking or tobacco-use cessation counseling service lasting more than 3 minutes and no more than 10 minutes.
Medicare pays $15.26 for 99406 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 99406 covers
This code describes individual counseling aimed at helping a patient stop smoking or using tobacco. A physician or other qualified health professional may discuss the health effects of tobacco, the patient’s readiness to quit, triggers and barriers, and practical steps such as setting a quit date or considering support options. The service may occur during an office or outpatient visit when the patient’s tobacco use is addressed as a distinct counseling service.
Select 99406 when the documented counseling time is more than 3 minutes and no more than 10 minutes; longer counseling falls into the next time tier. Record the tobacco-use discussion, counseling provided, time, and the patient’s response or cessation plan. CMS values the service through physician work, practice expense, and malpractice inputs; its practice-expense valuation differs between office and facility settings. The supplied CMS rules list no additional payment provisions for this code.
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.
99406 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $15.26 | $10.64 |
How the 99406 rate is calculated
Each of 99406’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 · 99406
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.24Practice expense 0.20Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99406
99406 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 · 99406
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$15.36
The facility rate would be $10.69 (+$4.67). In a facility, the facility bills its own costs separately.
99406 compared with similar codes
Compare codes
99406 vs 99407 vs 99401 vs 99408: national Medicare rates
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How to choose
- 99407Smoking cessation
- Use 99406 for more than 3 through 10 minutes of counseling; use 99407 when counseling exceeds 10 minutes.
- 99401Prev med cnsl indiv apprx 15
- 99401 is general individual preventive counseling. 99406 is the tobacco cessation-specific service with its own time threshold.
- 99408Audit/dast 15-30 min
- 99408 describes alcohol or drug screening and brief intervention, not counseling to stop smoking or tobacco use.
99406 billing questions
How does 99406 differ from 99407?
99406 covers more than 3 minutes through 10 minutes of individual tobacco cessation counseling. Use 99407 when the counseling exceeds 10 minutes.
Does brief advice to quit support 99406?
The documented counseling must exceed 3 minutes. A brief recommendation to stop smoking without that level of counseling does not meet this code’s time threshold.
What should the note include?
Document the tobacco-use issue addressed, counseling content, total counseling time, and the patient’s response or cessation plan.
Can this be reported with an office visit?
It may be reported for a distinct tobacco cessation counseling service performed during the same encounter as an office visit. The record should make the counseling service and its time clear.
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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