- Tobacco cessation counseling of more than three minutes is 99406 (0.24 wRVU); more than ten minutes is 99407 (0.50). Write the minutes and the substance, and add modifier 25 to the E/M when it rides on a problem visit.
- Cannabis, alcohol, and other drugs are not 99406 territory: they need a named screening instrument with its score plus 15 or more minutes, then 99408 or 99409 (Medicare G0396 or G0397).
- Medicare's obesity counseling code (G0447) and the alcohol-misuse screening codes follow the same rule: document that the service was delivered, the time, and the content.
- Telehealth levels are selected exactly like office visits, by MDM or total time. Only the code set, the modifier, and the place of service change.
- A commercial plan may accept the 2025 telemedicine codes (98000 through 98015); Medicare does not, and wants 99202 through 99215 with modifier 95 or 93 and place of service 10 or 02.
- Audio-only visits need more than 10 minutes of medical discussion, plus a note that says video was not used and where the patient was.
Real services, given away for free
Smoking cessation advice, obesity counseling, alcohol screening, and the video visit squeezed between clinic patients are real work with real codes that most clinicians never capture. Counseling codes fail for lack of one documented line; telehealth codes fail because the code set, modifier, and place of service change faster than any habit can track.
Counseling Services: Tobacco, Obesity, and the Work You Give Away
Tobacco Cessation Counseling
Two codes, selected by time. The work must be face-to-face counseling, not a passing mention, and the note must state the minutes and the product. More than three documented minutes is a code; three minutes never written down is goodwill.
| Code | Service | Time | wRVUs |
|---|---|---|---|
| 99406 | Tobacco cessation counseling, intermediate | more than 3, up to 10 min | 0.24 |
| 99407 | Tobacco cessation counseling, intensive | more than 10 min | 0.50 |
Which Products Count
The test is not whether the patient smokes. It is whether the product is a tobacco or nicotine product regulated as a tobacco product. Smoked, chewed, heated, or absorbed through the gum, all of it counts.
| Product | 99406 or 99407? | Diagnosis to use |
|---|---|---|
| Cigarettes, cigars, cigarillos, bidis, kreteks, pipe, hookah or shisha | Yes | F17.21 nicotine dependence, cigarettes |
| Chewing tobacco, snuff, dip, plug, snus | Yes | F17.22 nicotine dependence, chewing tobacco |
| Nicotine vaping and e-cigarettes, including disposables | Yes | F17.29 nicotine dependence, other tobacco product |
| Nicotine pouches (Zyn, On!, Rogue, Velo) | Yes | F17.29 nicotine dependence, other tobacco product |
| Heated tobacco, heat not burn devices | Yes | F17.29 nicotine dependence, other tobacco product |
| Cannabis or marijuana, smoked, vaped, dabbed, or eaten | No | F12 series; counsel under the substance codes below |
| Zero nicotine or nicotine free vaping | No | No cessation code exists; the counseling stays part of the visit |
| Alcohol and other drugs | No | Use the substance codes below |
Two points decide most audits. Nicotine pouches and heated tobacco are tobacco products even though nothing is burned, so they qualify. Cannabis smoking does not qualify no matter how it is delivered, because these two codes are written for tobacco and nicotine.
Nicotine replacement given as treatment, whether patch, gum, lozenge, varenicline, or bupropion, is prescription drug management for the visit. It is not a product the patient uses, and it never converts a cannabis conversation into a tobacco one.
How the Claim Works
- Both codes have no global period, so the office visit needs no modifier 25 to sit beside them. Report the visit, the counseling code, and G2211 when the relationship qualifies. If a commercial payer insists on modifier 25, remember that Medicare pays no G2211 on a visit carrying modifier 25, so on a Medicare claim adding it costs 0.33 wRVU.
- The counseling minutes belong to the counseling code alone. Counting them again in the visit total time is double counting.
- Medicare covers two quit attempts per year, four sessions each, eight sessions in total.
- When the whole management of the nicotine problem is the counseling, the problem belongs to the counseling code, not to the visit level. If the talk was three minutes and nothing codes, the problem returns to the visit as ordinary management.
Obesity Counseling
Medicare covers intensive behavioral therapy for obesity for qualifying patients, delivered face to face and reported with G0447. Primary care clinicians provide it visit after visit and code only the office visit; document the counseling delivered and the time spent.
Cannabis, Alcohol, and Other Drugs
Cannabis, alcohol, and other drug counseling has its own pathway, and it is stricter than tobacco. Two things must be in the note: a structured screening instrument with its score, and at least 15 minutes of face-to-face brief intervention. Without the instrument there is no code, however long the conversation.
| Code | Service | Time | wRVUs |
|---|---|---|---|
| 99408 | Structured screening and brief intervention, commercial payers | 15 to 30 min | 0.65 |
| 99409 | Structured screening and brief intervention, commercial payers | more than 30 min | 1.30 |
| G0396 | Same service for Medicare, which does not pay 99408 | 15 to 30 min | 0.65 |
| G0397 | Same service for Medicare | more than 30 min | 1.30 |
| G0442 | Medicare annual alcohol misuse screening | 15 min | 0.18 |
| G0443 | Medicare brief face-to-face alcohol misuse counseling, up to four sessions a year | 15 min | 0.60 |
Accepted instruments include AUDIT, AUDIT-C, DAST, ASSIST, CRAFFT, and CAGE. Name the instrument, write the score, then write what the intervention covered and how many minutes it took.
A patient who uses both nicotine and cannabis earns both pathways on the same day: the nicotine minutes support 99406 or 99407, and the cannabis instrument plus 15 minutes supports 99408. Keep the two sets of minutes separate in the note.
Counseling is lost because nobody wrote a number down. Telehealth is the opposite: the clinical note is usually fine, and the claim fails on the wrapper.
Telehealth: Coding Visits That Are Not In Person
Telehealth coding changed substantially in 2025 and is still settling; confirm every code and modifier below against current payer guidance before relying on it.
The Core Idea: Telehealth Visits Code Like Office Visits
Select the level exactly as you would in person, by medical decision making or by total time, then dress the claim for telehealth.
The 2025 Split: New Codes, but Not for Medicare
In 2025, CPT introduced dedicated telemedicine codes: 98000 through 98007 for audio-video and 98008 through 98015 for audio-only, each selected by MDM or total time with defined thresholds at each level. Modifier 95 is not required; the descriptor already says virtual.
Medicare will not accept them. For Medicare, report 99202 through 99215, append modifier 95 for audio-video or 93 for audio-only, and use the correct place of service.
| Payer | Audio-video visit | Audio-only visit | Telehealth modifier |
|---|---|---|---|
| Commercial plan that accepts the 2025 codes | 98000 through 98007 | 98008 through 98015 | None required; the descriptor says virtual |
| Medicare | 99202 through 99215 | 99202 through 99215 | 95 for audio-video, 93 for audio-only |
The same visit may be coded two ways in one week depending on the payer, which is why verifying each payer's stance is not optional.
Place of Service Is Not a Formality
Place of service says where the patient was, and a wrong one causes underpayment or denial even when the CPT code is correct: 10 when the patient is at home, 02 anywhere else. The pandemic-era allowance to keep place of service 11 (office) at the full in-office rate has been narrowing.
Audio-Only Has an Extra Requirement
Audio-only visits are payable in more circumstances than before, but must include more than 10 minutes of medical discussion, whether the level is set by MDM or by time. Under five minutes is not separately reportable. Record that video was not used, ideally why, and the time in discussion. A brief check-in code (98016) covers five-to-ten-minute synchronous contacts with established patients; it replaced the older Medicare check-in code.
Coding Telehealth by Time
A telehealth visit coded by time counts the same date-of-service activities as an in-person visit and states the total minutes the same way; what counts and how to write the time statement are in the time-based billing guide. Travel and general teaching never count. The prolonged-services add-on (99417) applies as in the office, in increments beyond the highest level's time threshold.
The Documentation That Protects a Telehealth Visit
Whatever the year's code set, a defensible telehealth note records four things.
- Modality: audio-video, or audio-only and why video was not used.
- Location: where the patient was at the time of the visit, which sets the place of service.
- Consent: the patient's agreement to a telehealth encounter, where your payer requires it.
- Clinical substance: the problems, data, and risk that support the level, and the total time if you coded by time.
The codes and modifiers will keep changing; a complete note is what survives the changes.
Sources and Further Reading for This Chapter
- CMS, Physician Fee Schedule. https://www.cms.gov/medicare/payment/fee-schedules/physician