CPT 99407
Global XXX ActiveBehav chng smoking > 10 min
CPT 99407 Billing & Documentation Guide
CPT code 99407 (Behav chng smoking > 10 min) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.5, a non-facility practice expense RVU of 0.33, and a malpractice RVU of 0.04, a total non-facility RVU of 0.87 and facility RVU of 0.66. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $29.69, though rates vary from $26.86 to $37.53 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99407, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99407 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99407 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99407
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.5 | 0.5 |
| Practice Expense RVU | 0.33 | 0.12 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 0.87 | 0.66 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99407
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $31.07 | $22.76 | $29.78 - $35.15 | 29 |
| Florida | $30.36 | $23.32 | $29.25 - $31.55 | 3 |
| Georgia | $28.84 | $22.15 | $28.12 - $29.55 | 2 |
| Illinois | $29.96 | $23.19 | $28.85 - $30.96 | 4 |
| Michigan | $28.93 | $22.35 | $28.27 - $29.59 | 2 |
| North Carolina | $27.84 | $21.29 | $27.84 - $27.84 | 1 |
| New York | $31.61 | $23.78 | $28.11 - $33.36 | 5 |
| Ohio | $28.11 | $21.71 | $28.11 - $28.11 | 1 |
| Pennsylvania | $29.08 | $22.21 | $28.08 - $30.07 | 2 |
| Texas | $28.89 | $21.98 | $27.97 - $29.62 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99407
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99407 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99407
What does CPT code 99407 mean? +
CPT code 99407 represents: Behav chng smoking > 10 min. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99407? +
The 2026 Medicare national average non-facility payment for CPT 99407 is $29.69. Rates range from $26.86 to $37.53 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99407? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99407? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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