Reimbursement for Tobacco Cessation in Fee for Service-below. The Value of Tobacco Treatment in Value-based contracts click here.

Tobacco cessation services are reimbursable in a fee for service payment model—and can generate substantial revenue when consistently billed. These services also support performance in value-based contracts, where providers are rewarded for improving outcomes and lowering overall care costs. Yet many clinicians do not routinely bill for add-on codes 99406 or 99407, even when eligible, often due to low perceived reimbursement, unfamiliarity with billing processes, or workflow challenge.

However, even brief counseling, Quitline referrals, and prescriptions for cessation medications can be reimbursed. When these interventions are performed consistently, the financial impact can be significant. Since 2008, clinical practice guidelines support an evidence-based intervention for every smoker, every visit, regardless of their readiness to change. Scheduled follow-ups to counselling double the impact of any intervention, and additional sessions further enhance outcomes. Cessation interventions apply to all types of tobacco. Here is a guide for billing CPT 99406 as an add-on code. The current national rate is $15.50.

The impact of routine counseling can be substantial.EMR data from WellSpan Health, a health system in Pennsylvania and Maryland, Vanderbilt, and UCLA showed that if every eligible tobacco cessation encounter were billed, the annual reimbursement potential would total $1.982 million, $805,000, and $314,000, respectively.

A 2024 study showed that patients in a smoking cessation registry had an average reduction of $42 in monthly health care costs, demonstrating population-level savings that benefit payors and can contribute to value-based care performance metrics8. These savings would exceed the calculated value of fee for service gains.

CMS (Centers for Medicare & Medicaid Services) guidelines, adopted by most payors, allow for up to eight cessation counseling sessions per patient, per year . CMS also allows tobacco cessation counseling to be delivered by auxiliary staff and billed by the supervising practitioner when delivered "incident to" an office visit.

The American Lung Association provides additional medical record documentation standards.

Want to see how this adds up in your practice?

Use the simple tool below to estimate what your practice could earn by consistently billing for tobacco cessation services.
Enter the number of adult ambulatory visits, local tobacco use prevalence, payor mix (Medicare/Medicaid/Commercial), and reimbursement rates for each. The calculator will estimate annual reimbursement totals. Shortcut: For a quick estimate, use the standard Medicare payment rate of $15.50 per counseling visit.

  1. Try the Calculator Go to the XL Worksheet here
    ✓ Formulas are locked
    ✓ Make a copy to use the tool freely

  2. Alternative approach: Use your EHR to calculate the number of tobacco users that could be billed and subtract the number actually billed.

Resources and tools to support changes in office workflow and other systems change:

Tobacco Cessation Change Package (hhs.gov) (The Million Heart Initiative)

American Academy of Family Practice Office Champions

Practice leaders and administrators are invited to “do the math” and estimate the impact. Follow the link to an XL spreadsheet that supports an estimate of the reimbursement based on billing every smoker for a 3-minute counselling cessation. . Go to the XL Worksheet here to do the math for your practice. References and tools are a click away.

Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program - ScienceDirect. The is no doubt that additional savings will accrue in subsequent years.

The cost of implementing systems-based improvements in smoking cessation is modest and the benefits continue to accrue and increase over future years that members are retained.