How much does Medicare pay for CPT 99407?

Medicare allowed an average of $25.83 per service and paid $25.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $62.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99407?

Smoking and tobacco use intensive counseling, more than 10 minutes. It was billed 40,590 times to 24,518 Medicare beneficiaries by 777 providers in 2024.

Does 99407 pay differently in an office than a hospital?

Yes. The allowed amount averaged $26.11 in an office setting and $23.58 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 99407 most?

Internal Medicine, with 10,701 services from 203 clinicians. Next are Nurse Practitioner, Family Practice, Pulmonary Disease.

CPT 99407

Smoking and tobacco use intensive counseling, more than 10 minutes

$25.83Medicare-allowed amount per service, averaged across 40,590 services

Providers submitted

$62.38

Asking price, not received

Medicare allowed

$25.83

The fee schedule figure

Medicare paid

$25.83

Balance is patient coinsurance

Providers submitted an average of $62.38 for this code and Medicare allowed $25.83 — 2.4× 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 $25.83 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $26.11
Hospital / facility: $23.58

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. 36,078 services were billed in an office setting and 4,512 in a facility.

Services: 40,590
Beneficiaries: 24,518
Providers billing it: 777
Total allowed: $1,048,440

What Medicare pays for CPT 99407

Across 40,590 services billed by 777 providers to 24,518 beneficiaries, Medicare allowed an average of $25.83 per service. That is 1.7 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 99407

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	10,701	6,163	$26.96	203
Nurse Practitioner	10,029	5,649	$22.85	142
Family Practice	5,529	3,017	$27.16	102
Pulmonary Disease	4,328	2,928	$27.12	134
Physician Assistant	2,241	1,740	$23.79	32
Cardiology	1,645	1,138	$26.98	46
Emergency Medicine	980	611	$27.66	10
Orthopedic Surgery	772	349	$28.27	2
General Practice	684	462	$27.45	12
Critical Care (Intensivists)	580	406	$26.66	18
Hospitalist	403	360	$24.70	21
Vascular Surgery	340	253	$26.51	10
Osteopathic Manipulative Medicine	301	133	$28.19	2
Urology	218	190	$28.72	1
Infectious Disease	196	78	$28.29	1

99407 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
California	16,921	$26.14	$24.85	168
Texas	2,868	$24.64	$25.17	56
Florida	2,281	$26.46	$25.52	65
Michigan	2,130	$27.30	$26.53	29
New York	1,988	$28.91	$26.08	66
Illinois	1,627	$26.66	$25.56	30
Nevada	1,239	$21.94	$22.89	17
Massachusetts	1,132	$25.85	$25.09	32
New Jersey	1,099	$27.90	$25.96	36
Maryland	980	$26.85	$25.60	23
North Carolina	923	$24.61	$25.75	28
Louisiana	757	$24.61	$25.96	18
Georgia	732	$25.12	$25.58	27
Indiana	656	$22.58	$23.94	22
Pennsylvania	547	$25.33	$24.89	19
Arizona	478	$24.58	$25.07	13
Mississippi	469	$23.16	$24.75	9
Kentucky	440	$24.44	$25.99	13
Ohio	421	$23.04	$23.52	12
Tennessee	242	$24.27	$25.58	11
Arkansas	239	$21.77	$23.64	9
Alabama	217	$24.81	$26.65	4
Virginia	198	$25.99	$25.86	6
Connecticut	196	$26.25	$24.67	4
Oklahoma	182	$24.83	$25.86	6
South Carolina	177	$23.10	$25.22	8
New Hampshire	165	$23.60	$23.44	3
District of Columbia	145	$27.71	$24.47	2
Delaware	123	$26.84	$26.70	3
New Mexico	115	$25.04	$25.54	1
Missouri	111	$26.11	$26.54	5
Wisconsin	90	$22.47	$23.37	5
Washington	89	$26.39	$25.40	2
Montana	69	$20.33	$20.36	2
Nebraska	59	$20.52	$21.64	2
West Virginia	58	$22.16	$22.59	2
Oregon	49	$23.39	$23.97	3
Minnesota	48	$24.35	$24.22	3
Guam	47	$29.20	$26.68	1
Rhode Island	46	$23.12	$22.64	1
Maine	44	$21.84	$22.45	2
Colorado	43	$25.63	$25.75	3
XX	32	$26.86	$26.70	1
Utah	30	$22.14	$22.74	1
Kansas	28	$24.17	$25.52	1
Iowa	26	$25.13	$26.63	1
Vermont	23	$29.76	$26.69	1
North Dakota	11	$23.28	$24.10	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.