How much does Medicare pay for CPT 99406?

Medicare allowed an average of $13.38 per service and paid $13.38 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $37.89, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99406?

Smoking and tobacco use intensive counseling, 4-10 minutes. It was billed 179,352 times to 119,836 Medicare beneficiaries by 5,428 providers in 2024.

Does 99406 pay differently in an office than a hospital?

Yes. The allowed amount averaged $13.73 in an office setting and $10.88 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99406 most?

Internal Medicine, with 35,785 services from 1,109 clinicians. Next are Nurse Practitioner, Family Practice, Pulmonary Disease.

CPT 99406

Smoking and tobacco use intensive counseling, 4-10 minutes

$13.38Medicare-allowed amount per service, averaged across 179,352 services

Providers submitted

$37.89

Asking price, not received

Medicare allowed

$13.38

The fee schedule figure

Medicare paid

$13.38

Balance is patient coinsurance

Providers submitted an average of $37.89 for this code and Medicare allowed $13.38 — 2.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $13.38 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $13.73
Hospital / facility: $10.88

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 157,216 services were billed in an office setting and 22,136 in a facility.

Services: 179,352
Beneficiaries: 119,836
Providers billing it: 5,428
Total allowed: $2,399,730

What Medicare pays for CPT 99406

Across 179,352 services billed by 5,428 providers to 119,836 beneficiaries, Medicare allowed an average of $13.38 per service. That is 1.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99406

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	35,785	23,733	$14.02	1,109
Nurse Practitioner	32,208	20,646	$11.35	967
Family Practice	31,171	19,793	$13.86	999
Pulmonary Disease	23,018	16,541	$13.87	654
Cardiology	15,055	10,744	$14.24	435
Physician Assistant	7,285	4,915	$11.62	246
Interventional Cardiology	3,794	2,841	$13.77	110
Vascular Surgery	3,705	2,869	$14.09	130
Pain Management	3,014	1,144	$14.11	27
General Practice	2,383	1,365	$14.54	46
Critical Care (Intensivists)	2,318	1,598	$14.11	76
Anesthesiology	2,233	1,077	$14.54	29
Hospitalist	2,032	1,844	$11.86	92
Emergency Medicine	1,903	1,651	$12.78	82
Neurology	1,278	776	$14.37	26

99406 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	14,066	$15.09	$13.78	427
California	13,785	$14.51	$13.69	324
Florida	13,576	$13.75	$13.56	365
Texas	10,295	$12.78	$13.01	280
North Carolina	9,682	$12.84	$13.44	310
Michigan	8,997	$13.83	$13.75	259
Illinois	8,851	$13.25	$12.81	240
Georgia	6,993	$13.48	$13.94	235
Massachusetts	6,466	$13.60	$13.12	217
New Jersey	6,430	$15.26	$14.10	178
Tennessee	5,944	$12.39	$13.34	219
Virginia	5,459	$12.95	$13.13	183
Indiana	5,308	$12.30	$13.01	158
Maryland	5,221	$14.06	$13.59	148
Oklahoma	5,023	$12.35	$13.42	111
Ohio	4,985	$12.21	$12.65	176
Kentucky	4,810	$12.77	$13.37	155
Pennsylvania	4,642	$13.85	$13.66	150
Mississippi	3,877	$12.29	$12.92	119
South Carolina	3,857	$13.09	$13.69	137
Alabama	3,713	$12.73	$13.93	115
Arkansas	3,435	$12.26	$13.29	101
Arizona	3,005	$13.26	$13.47	106
Nevada	2,583	$12.43	$12.70	68
Louisiana	2,468	$12.63	$13.45	88
Missouri	2,390	$12.11	$12.63	87
Washington	1,243	$13.61	$13.46	46
Kansas	1,057	$12.12	$13.02	38
Delaware	1,042	$13.62	$13.69	38
Wisconsin	1,010	$11.64	$12.29	39
Colorado	1,005	$13.75	$13.56	29
Oregon	988	$13.02	$13.28	36
New Mexico	788	$12.15	$12.76	17
Nebraska	748	$11.97	$12.97	27
Connecticut	715	$14.95	$14.02	27
West Virginia	692	$12.04	$12.33	27
Minnesota	518	$11.88	$12.20	26
Guam	457	$14.50	$13.93	8
New Hampshire	407	$12.23	$12.03	18
District of Columbia	404	$13.32	$12.77	8
Maine	360	$10.67	$10.89	12
Montana	335	$11.31	$11.36	15
Iowa	256	$11.49	$12.16	13
Idaho	250	$11.24	$11.55	8
North Dakota	212	$11.80	$11.80	9
South Dakota	157	$11.74	$11.94	3
Rhode Island	152	$11.43	$11.80	2
Vermont	151	$11.49	$11.82	6
Utah	141	$13.17	$13.18	5
Alaska	106	$16.56	$12.58	5
Wyoming	103	$14.01	$14.05	6
Hawaii	101	$14.88	$14.29	2
Puerto Rico	65	$14.27	$14.31	1
ZZ	28	$11.29	$11.39	1

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.