Billing to Insurance

Below are common billing codes taken from A clinical practice guideline for treating tobacco use and dependence: 2008 update: a US public health service report. 

Content is organized by appointment type, starting with codes for practitioners in medical settings and ending with codes for practitioners in alternative clinical settings (e.g. occupational therapy, dental).

New Patient Initial or Periodic Comprehensive Preventive Medicine Examination

For new patients, initial intake or periodic comprehensive preventive medical examination, use the below billing codes according to patient’s age. These codes are meant for initial comprehensive preventive medicine evaluation and management of a patient, including examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations and laboratory/diagnostic procedures.

Billing Code           Age

99383                 5 – 11 years
99384               12 – 17 years
99385               18 – 39 years
99386               40 – 64 years
99387               65 and older

Established Patient Initial or Periodic Comprehensive Preventive Medicine Examination

For established patients, reevaluation and management of an individual, use the below codes according to patient’s age. These billing codes are meant for age appropriate history examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient.

Billing Code           Age

99393                 5 – 11 years
99394               12 – 17 years
99395               18 – 39 years
99396               40 – 64 years
99397               65 and older

Counseling and/or Risk Factor Reduction Intervention 

For patients who are seeking individual counseling and/or risk factor reduction interventions, use the billing codes below according to the session times spent with patient.

Billing Code           Time

99401               ~15 minutes
99402               ~30 minutes
99403               ~45 minutes
99404               ~60 minutes

Counseling and/or Risk Factor Reduction Intervention – Individual Counseling

For patients who are seeking individual smoking cessation counseling by a physician or other qualified healthcare professionals, using “standardized, evidence-based screening instruments and tools with reliable documentation and appropriate sensitivity, use the billing codes below according to amount of time spent with patients.

Billing Code             Time

99406                 3 – 10 minutes
99407               more than 30 minutes

Counseling and/or Risk Factor Reduction Intervention – Group Counseling

For patients who are seeking group counseling and/or intervention to treat the risk factor of tobacco use, use the billing codes below according to amount of time spent with patients.

Billing Code             Time

99411                ~30 minutes
99412               ~60 minutes

Office or Other Outpatient Facility 

For patients who are seeking individual psychotherapy plus medical evaluation and management services.

Billing Code             Time

90805                20-30 minutes
90807               45-50 minutes
90809                75-80 minutes

Inpatient Hospital, Partial Hospital, or Residential Care Facility

For individual psychotherapy (e.g. insight-oriented, behavior modifying, supportive) in an inpatient hospital, partial hospital, or residential care setting, face-to-face with patient.

Billing Code             Time

90816                  20-30 minutes

90818                  45-50 minutes

90821                  75-80 minutes

For patients who are seeking the individual psychotherapy plus medical evaluation and management services.

Billing Code             Time

90817                  20-30 minutes

90819                  45-50 minutes

90822                  75-80 minutes

Other Psychotherapy and Dental Codes

For other psychotherapy offices not mentioned above, such as Occupational Therapy, use code 90853.

For dental offices offering tobacco counseling for the control and prevention of oral disease, use code D1320.