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Welcome  » January 24, 2022 11:31 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Outpatient Mental Health
01/24/2022  

Covered and Noncovered Services : Covered Services and Requirements

Topic #19019

Concurrent Behavioral Treatment and Behavioral Health Services

ForwardHealth will allow for the concurrent delivery of behavioral treatment services with behavioral health services when both services are identified as medically necessary, per Wis. Admin. Code § DHS 101.03(96m).

ForwardHealth recognizes that coordinated services between behavioral treatment and behavioral health providers may be clinically appropriate.

Topic #6057

Covered Central Nervous System Assessments/Tests

Covered central nervous system assessments/tests include the following:

  • Psychological testing
  • Assessment of aphasia
  • Developmental testing, limited and extended
  • Neurobehavioral status exams
  • Neuropsychological testing

Specific services include assessments and tests with interpretations and reports. BadgerCare Plus and Wisconsin Medicaid cover all of the Central Nervous System Assessments/Tests described in CPT. A list of allowable procedure codes and modifiers is available.

Topic #6077

Covered Health and Behavior Assessment and Intervention Services

Health and behavior assessment and intervention services are those offered to members who present with primary physical illnesses, diagnoses, or symptoms and may benefit from assessments and interventions that focus on the biopsychosocial factors related to the member's health status. These services do not represent preventive medicine counseling and risk factor reduction interventions.

BadgerCare Plus and Wisconsin Medicaid cover all of the health and behavior assessment and intervention services described in CPT. A list of allowable procedure codes and modifiers is available.

Topic #6037

Covered Outpatient Mental Health Services

Outpatient mental health services include strength-based assessments (including differential diagnostic evaluations), psychotherapy services, mental health clinical consultations, and other psychiatric services in the following settings:

  • Home (for members under 21 years of age and the parent[s] of the member)
  • Office of a provider
  • Hospital
  • Nursing home
  • School
  • Hospital outpatient clinic
  • Outpatient clinic

The intensity and modality of treatment should be adjusted to the individual needs of the member. If the nature and severity of the member's disorder requires more intensive treatment than can be safely provided by an outpatient mental health clinic or licensed psychotherapist, a higher LOC should be considered. Examples of circumstances when it may be appropriate to provide outpatient mental health treatment for individuals with higher than typical needs include:

  • For a member discharged from an inpatient, residential, or day treatment program in the last 90 days and more frequent treatment is required for stabilization during the member's transition to less restrictive care
  • For a member initiating primary treatment in an evidence-based modality that supports a limited period of more frequent intervention
  • For a member experiencing a sudden, unexpected increase in symptoms and/or behaviors that can be immediately stabilized with more frequent treatment on an outpatient basis (If more frequent treatment does not reduce the heightened severity of the member's disorder, the member should be referred to a higher LOC.)

Strength-Based Assessments

A strength-based assessment, including a differential diagnostic evaluation, is performed by a Medicaid-enrolled psychotherapy provider. A physician's prescription is not necessary to perform the assessment. Assessing and recovery/treatment planning is an ongoing process in collaboration between the provider and member.

The strength-based assessment must include the following:

  • The member's presenting problem
  • Diagnosis established from the current DSM including all five axes or, for children up to age 4, the current Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood
  • The member's symptoms that support the given diagnosis
  • The member's strengths and current and past psychological, social, and physiological data; information related to school or vocational, medical, and cognitive function; past and present trauma; and substance abuse
  • The member's unique perspective and own words about how they view their recovery, experience, challenges, strengths, needs, recovery goals, priorities, preferences, values, and lifestyle, areas of functional impairment, and family and community support
  • Barriers and strengths to the member's progress and independent functioning
  • Necessary consultation to clarify the diagnosis and treatment

Psychotherapy and Treatment/Recovery Planning

Psychotherapy services include strategies to reduce the severity and distress of persistent symptoms, promote personal insight, assist in coping with symptoms, and identify supports that are effective. In addition, services may include individual and family psychoeducation to help the individual and family members develop coping skills for handling problems posed by mental illness in a family member.

The goals of psychotherapy and specific objectives to meet those goals must be documented in the member's treatment/recovery plan that is based on the strength-based assessment. The treatment/recovery plan includes documentation of the signs of improved functioning that will be used to measure progress toward specific objectives at identified intervals as agreed upon by the provider and member. A mental health diagnosis and medications for mental health issues used by the member must be documented in the treatment/recovery plan.

ForwardHealth covers most of the psychiatry services described in CPT.

A list of allowable procedure codes and modifiers for strength-based assessments and psychotherapy and treatment/recovery planning is available.

Mental Health Clinical Consultations

A mental health clinical consultation is a communication from a mental health provider to coordinate services for a BadgerCare Plus or Medicaid beneficiary who is a student under 21 years of age with an established mental health diagnosis or with the parent of the student. The intent of the mental health consultation is to inform individuals working with the member or the parent(s) of the member of the following:

  • Member's symptoms
  • Strategies for effective engagement, care, and intervention
  • Treatment expectations for the member

Per Wis. Stat. § 49.45(29y)(a)2m, a parent is defined as any of the following:

  • A parent
  • A foster parent
  • A guardian
  • A relative, other than a parent, who lives with the student

Mental health clinical consultations are reimbursable between an enrolled mental health provider who is currently allowed to render outpatient mental health services and any of the following:

  • Educator teams
  • Individual educators
  • School staff
  • Parent(s) of the member

Mental health clinical consultations may be provided via phone or face-to-face interviews. The content and duration of the mental health clinical consultation must be documented. Mental health clinical consultations follow the same documentation requirements as other outpatient mental health services.

Informed Consent

Per Wis. Stat. § 146.81(2), mental health providers are expected to obtain informed consent from the member, the member's parent or legal custodian, or the member's legal representative, as appropriate, before conducting the mental health clinical consultations. Providers should consult with their own legal counsel if they have questions about informed consent requirements.

Topic #3724

Within the provision of mental health and substance abuse services, BadgerCare Plus encourages the concept of recovery for all persons who receive services. This includes consumer involvement in assessment, treatment planning, and outcomes. Also, BadgerCare Plus promotes the use of evidence-based and culturally competent practices.

Topic #44

Definition of Covered Services

A covered service is a service, item, or supply for which reimbursement is available when all program requirements are met. Wis. Admin. Code § DHS 101.03(35) and ch. DHS 107 contain more information about covered services.
Topic #85

Emergencies

Certain program requirements and reimbursement procedures are modified in emergency situations. Emergency services are defined in Wis. Admin. Code § DHS 101.03(52), as "those services that are necessary to prevent the death or serious impairment of the health of the individual." Emergency services are not reimbursed unless they are covered services.

Additional definitions and procedures for emergencies exist in other situations, such as dental and mental health.

Program requirements and reimbursement procedures may be modified in the following ways:

  • PA or other program requirements may be waived in emergency situations.
  • Non-U.S. citizens may be eligible for covered services in emergency situations.
Topic #21337

Expectations and Documentation Requirements for Collaborating Providers

Whether or not PA is required for a service, each provider must separately document their collaboration with the other provider in the member's medical record. The documentation must include services the member is receiving from the other provider and the current schedule of services or the frequency of services from both providers. This will ensure better coordination and continuity of care and will prevent duplication of services.

ForwardHealth requires providers to coordinate with each other at least once every six months, or more often if indicated by the member's condition.

The following shows care collaboration requirements for a collaborating behavioral health provider under two possible scenarios:

  • If a behavioral health provider intends to provide a service that requires PA, the behavioral health provider must include the mode and frequency of the coordination between themselves and the collaborating behavioral treatment provider in the PA request and the member's medical record.
  • If a behavioral health provider is providing a service that does not require PA, the behavioral health provider must document coordination between themselves and the collaborating behavioral treatment provider in the member's medical record.

Services That Require PA

Collaborating providers must include the following information in their PA request:

  • The concurrent services received by the member
  • The mode and frequency of the care collaboration between providers (for example, phone calls, meetings, the member's weekly schedule)

Note: ForwardHealth may request additional information, if needed, to establish the medical necessity of the service.

In the event a provider experiences challenges obtaining the required documentation from their collaborating provider, ForwardHealth recommends that the provider submit the PA request, detailing the barriers to obtaining the required documentation. ForwardHealth will consider the current barriers and may allow flexibility to authorize services as appropriate.

Topic #20297

Outpatient Mental Health and Outpatient Substance Abuse

The medical necessity must be documented in the member's records and include a current assessment of the member's needs and treatment plan. The assessment and treatment plan must be updated as the needs of the member change. Documentation in progress notes may be used to inform the assessment and treatment planning process, but does not replace the requirement for current documentation of a distinct assessment and treatment plan.

If progress towards the measurable goals identified in the treatment plan does not occur, the treatment plan must be amended with modifications to the treatment approach in order to address any barriers to progress, or with more appropriate goals.

Topic #84

Medical Necessity

Wisconsin Medicaid reimburses only for services that are medically necessary as defined under Wis. Admin. Code § DHS 101.03(96m). Wisconsin Medicaid may deny or recoup payment if a service fails to meet Medicaid medical necessity requirements.

Topic #86

Member Payment for Covered Services

Under state and federal laws, a Medicaid-enrolled provider may not collect payment from a member, or authorized person acting on behalf of the member, for covered services even if the services are covered but do not meet program requirements. Denial of a claim by ForwardHealth does not necessarily render a member liable. However, a covered service for which PA was denied is treated as a noncovered service. (If a member chooses to receive an originally requested service instead of the service approved on a modified PA request, it is also treated as a noncovered service.) If a member requests a covered service for which PA was denied (or modified), the provider may collect payment from the member if certain conditions are met.

If a provider collects payment from a member, or an authorized person acting on behalf of the member, for a covered service, the provider may be subject to program sanctions including termination of Medicaid enrollment.

Topic #3726

Physician Prescription

The following prescription requirements apply to a physician or other health care provider initiating mental health and substance abuse treatment services for a Wisconsin Medicaid and BadgerCare Plus member.

Benefits That Require a Prescription or Order to Initiate Services

Wisconsin Medicaid and BadgerCare Plus require a prescription or order from a physician or other health care provider prior to initiating certain community-based mental health services for a Wisconsin Medicaid and BadgerCare Plus member. Examples of these services include the following:

  • Community Support Programs
  • Comprehensive Community Services
  • HealthCheck "Other Services" Child/Adolescent Day Treatment
  • HealthCheck "Other Services" Intensive In-Home Mental Health and Substance Abuse Treatment Services for Children

Benefits That Do Not Require a Prescription to Initiate Services

Wisconsin Medicaid and BadgerCare Plus do not require a prescription from a physician or other health care provider to initiate the following mental health and substance abuse treatment services for a Wisconsin Medicaid and BadgerCare Plus member:

  • Outpatient mental health services provided in a Medicaid-enrolled outpatient mental health clinic or in the home for members under 21 years of age
  • Outpatient substance abuse treatment provided in a Medicaid-enrolled substance abuse clinic
  • Adult mental health day treatment
  • Substance abuse day treatment
  • Outpatient mental health and substance abuse services in the home or community for adults
  • Outpatient mental health and substance abuse services performed in private practice by a Medicaid-enrolled psychiatrist, Ph.D. psychologist, APNP with psychiatric specialty, or a licensed psychotherapist (referred to as licensed mental health professional in Wisconsin law)
Topic #6097

Coverage of Outpatient Mental Health Services Concurrent With Other Mental Health or Substance Abuse Services

Policies regarding concurrent coverage of services are as follows:

  • Wisconsin Medicaid covers a continuum of non-inpatient hospital substance abuse and mental health services, including day treatment and psychotherapy.
  • Wisconsin Medicaid covers outpatient substance abuse services concurrently with outpatient mental health and/or adult mental health day treatment services as long as both services are medically necessary and appropriate.

Outpatient Mental Health Services for Children When Provided in the Home

Allowable provider types for outpatient mental health services for children provided in the home are the same as the allowable provider types for outpatient mental health services provided in a clinic setting. Outpatient mental health services for children provided in the home must be provided by a Medicaid-enrolled mental health provider working through a Wisconsin DHS 35-certified outpatient mental health clinic. Providers not working through a DHS 35-certified clinic may not receive reimbursement for outpatient mental health services provided in the home. Since a provider must be working through a DHS 35-certified outpatient mental health clinic, all the requirements indicated in Wis. Admin. Code ch. DHS 35 apply, including the requirement that a clinic providing services to persons 13 years of age and younger must have qualified staff with appropriate training and experience available to work with children and adolescents.

When submitting a claim for outpatient mental health services for children provided in the home, providers should list the NPI of the DHS 35-certified outpatient mental health clinic as the biller. If the rendering provider's NPI is different from the billing provider's NPI, providers should also list the NPI of the rendering provider on the claim.

Coordination With Intensive In-Home Mental Health and Substance Abuse Treatment Services for Children

Members may not concurrently receive mental health services for children provided in the home covered under the outpatient mental health benefit and intensive in-home mental health and substance abuse treatment services for children covered under the HealthCheck "Other Services" benefit. If a member is eligible for both mental health services for children provided in the home covered under the outpatient mental health benefit and intensive in-home mental health and substance abuse treatment services for children covered under the HealthCheck "Other Services" benefit, the provider should determine the most appropriate benefit under which to provide services.

Topic #66

Program Requirements

For a covered service to meet program requirements, the service must be provided by a qualified Medicaid-enrolled provider to an enrolled member. In addition, the service must meet all applicable program requirements, including, but not limited to, medical necessity, PA, claims submission, prescription, and documentation requirements.

Topic #17058

Prolonged Services With Psychotherapy

The following prolonged services add-on procedure codes can be used with CPT procedure code 90837 (Psychotherapy, 60 minutes with patient) if a provider renders more than 60 minutes of psychotherapy:

  • 99354 (Prolonged service[s] in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour). Procedure code 99354 can only be used in conjunction with procedure code 90837 and can only be used once an additional 30 minutes of services are provided. (The first 1–29 additional minutes beyond the initial 60 minutes are not separately reimbursable per CPT guidelines.)
  • 99355 (Prolonged service[s] in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes). Procedure code 99355 can only be used in conjunction with procedure codes 99354 and 90837.

Providers should refer to CPT coding guidelines for prolonged services for more information.

The following table indicates the CPT procedure code(s) that appropriately match the actual time spent providing the prolonged service. The table does not account for the first 60 minutes of psychotherapy covered by procedure code 90837.

Total Duration of Prolonged Services Procedure Code(s)
Less than 30 minutes Not reported separately
30–74 minutes

(30 minutes–one hour, 14 minutes)

99354 x 1*
75–104 minutes

(one hour, 15 minutes–one hour, 44 minutes)

99354 x 1* and 99355 x 1*
105 or more minutes

(one hour, 45 minutes or more)

99354 x 1* and 99355 x 2* or more for each additional 30 minutes

* Refers to the number of units to put on the claim form.

Providers are required to indicate the appropriate professional level modifier when submitting claims for prolonged services. Providers are required to use informational modifier UC with all procedure codes under this benefit.

Service Limitations

Procedure code 99354 is limited to one unit per DOS.

Procedure code 99355 is limited to four units per DOS.

Reporting Psychotherapy Time-Based Procedure Codes

Psychotherapy CPT procedure codes are time-based codes representing 30, 45, and 60 minutes of services. A unit of time has been reached when a provider has completed 51 percent of the designated time. To report psychotherapy, the session time must be at least 16 minutes. The proper procedure code is then selected based on the actual time closest to the time written in the code descriptor. This represents an actual time of 16 to 37 minutes for the 30-minute procedure codes (codes 90832 and 90833), 38 to 52 minutes for the 45-minute procedure codes (codes 90834 and 90836), and 53 minutes or greater for the 60-minute procedure codes (codes 90837 and 90838).

Topic #824

Services That Do Not Meet Program Requirements

As stated in Wis. Admin. Code § DHS 107.02(2), BadgerCare Plus and Wisconsin Medicaid may deny or recoup payment for covered services that fail to meet program requirements.

Examples of covered services that do not meet program requirements include the following:

  • Services for which records or other documentation were not prepared or maintained
  • Services for which the provider fails to meet any or all of the requirements of Wis. Admin. Code § DHS 106.03, including, but not limited to, the requirements regarding timely submission of claims
  • Services that fail to comply with requirements or state and federal statutes, rules, and regulations
  • Services that the Wisconsin DHS, the PRO review process, or BadgerCare Plus determines to be inappropriate, in excess of accepted standards of reasonableness or less costly alternative services, or of excessive frequency or duration
  • Services provided by a provider who fails or refuses to meet and maintain any of the enrollment requirements under Wis. Admin. Code ch. DHS 105
  • Services provided by a provider who fails or refuses to provide access to records
  • Services provided inconsistent with an intermediate sanction or sanctions imposed by DHS
Topic #510

Telehealth

Information is available for DOS before July 1, 2021.

ForwardHealth allows certain covered services to be provided via telehealth (also known as "telemedicine"). Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.

Allowable Providers

There is no restriction on the location of a distant site provider. In addition, there are no limitations on what provider types may be reimbursed for telehealth services.

Allowable Originating Sites

ForwardHealth allows coverage of telehealth for any originating site. However, only the following originating sites are eligible for a facility fee reimbursement:

  • Hospitals, including emergency departments
  • Office/clinic
  • Skilled nursing facility

Requirements and Restrictions

Services provided via telehealth must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face visit where both the rendering provider and member are in the same physical location. Both the distant and originating sites must have the requisite equipment and staffing necessary to provide the telehealth service.

Coverage of a service provided via telehealth is subject to the same restrictions as when the service is provided face to face (for example, allowable providers, multiple service limitations, PA).

Providers are reminded that HIPAA confidentiality requirements apply to telehealth services. When a covered entity or provider utilizes a telehealth service that involves PHI, the entity or provider will need to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to PHI confidentiality, integrity, and availability. Each entity or provider must assess what are reasonable and appropriate security measures for their situation.

Note: Providers may not require the use of telehealth as a condition of treating a member. Providers must develop and implement their own methods of informed consent to verify that a member agrees to receive services via telehealth. These methods must comply with all federal and state regulations and guidelines.

Noncovered Services

Services that are not covered when delivered in person are not covered as telehealth services. In addition, services that are not functionally equivalent to the in-person service when provided via telehealth are not covered.

Claims Submission and Reimbursement for Distant Site Providers

Claims for services provided via telehealth by distant site providers must be billed with the same procedure code as would be used for a face-to-face encounter along with HCPCS modifier GT (via interactive audio and video telecommunication systems).

Claims must also include POS code 02 (Telehealth: the location where health services and health-related services are provided or received through telehealth telecommunication technology). ForwardHealth reimburses the service rendered by distant site providers at the same rate as when the service is provided face-to-face.

Ancillary Providers

Claims for services provided via telehealth by distant site ancillary providers should continue to be submitted under the supervising physician's NPI using the lowest appropriate level office or outpatient visit procedure code or other appropriate CPT code for the service performed. These services must be provided under the direct on-site supervision of a physician who is located at the same physical site as the ancillary provider and must be documented in the same manner as services that are provided face to face.

Pediatric and Health Professional Shortage Area-Eligible Services

Claims for services provided via telehealth by distant site providers may additionally qualify for pediatric (services for members 18 years of age and under) or HPSA-enhanced reimbursement. Pediatric and HPSA-eligible providers are required to indicate POS code 02, along with modifier GT and the applicable pediatric or HPSA modifier, when submitting claims that qualify for enhanced reimbursement.

Claims Submission and Reimbursement for Originating Site Facility Fee

In addition to reimbursement to the distant site provider, ForwardHealth reimburses an originating site facility fee for the staff and equipment at the originating site requisite to provide a service via telehealth. Eligible providers who serve as the originating site should bill the facility fee with HCPCS procedure code Q3014 (Telehealth originating site facility fee). HCPCS modifier GT should not be included with procedure code Q3014.

Eligible providers who bill on a professional claim form should bill Q3014 with a POS code that represents where the member is located during the service. The POS must be a ForwardHealth-allowable originating site for procedure code Q3014 in order to be reimbursed for the originating site fee. The originating site fee is reimbursed based on a maximum allowable fee.

Eligible providers who bill on an institutional claim form should bill Q3014 as a separate line item with the appropriate revenue code. ForwardHealth will reimburse these providers for the facility fee based on the provider's standard reimbursement methodology.

Documentation Requirements

All services provided via telehealth must be thoroughly documented in the member's medical record in the same manner as services provided face to face. As a reminder, documentation for originating sites must support the member's presence in order to submit a claim for the originating site facility fee. In addition, if the originating site provides and bills for services in addition to the originating site facility fee, documentation in the member's medical record should distinguish between the unique services provided.

Telestroke Services

Telestroke, also known as stroke telemedicine, is a delivery mechanism of telehealth services that aims to improve access to recommended stroke treatment.

ForwardHealth allows providers to be reimbursed for telestroke services. Telestroke services typically consist of the member and emergency providers at an originating site consulting with a specialist located at a distant site.

Claims Submission for Telestroke Services

Providers are required to use CPT consultation and E&M procedure codes when billing telestroke services. Telestroke services are subject to the same enrollment policy, coverage policy, and billing policy as telehealth services. All other services rendered by the provider at the originating site, and by any providers to which the member is transferred, should be billed in the same manner as visits or admissions that do not involve telehealth services.

Originating sites that have established contractual relationships for telestroke services may bill as they would for any other contracted professional services for both the professional service claim on behalf of the distant site provider and the originating site fee.

Additional Policy for Certain Types of Providers

Out-of-State Providers

ForwardHealth policy for services provided via telehealth by out-of-state providers is the same as ForwardHealth policy for services provided face to face by out-of-state providers. Out-of-state providers who do not have border status enrollment with Wisconsin Medicaid are required to obtain PA before providing services via telehealth to BadgerCare Plus or Medicaid members.

Note: Wisconsin Medicaid is prohibited from paying providers located outside of the United States and its territories, including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

Federally Qualified Health Centers and Rural Health Clinics

For the purpose of this Online Handbook topic, FQHC refers to Tribal and Out-of-State FQHCs. This topic does not apply to Community Health Centers subject to PPS reimbursement.

FQHCs and RHCs may serve as originating site and distant site providers for telehealth services.

Distant Site

FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the FQHC or RHC at the time of the telehealth service.

Services billed with modifier GT (modifier indicating telehealth) will be considered under the PPS reimbursement method for non-tribal FQHCs. Billing HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS rate for fee-for-service encounters.

Originating Site

The originating site facility fee is not a FQHC or RHC reportable encounter on the cost report. Any reimbursement for the originating site facility fee must be reported as a deductive value on the cost report.

Allowable Services

Procedure codes for services allowed under permanent telehealth policy have POS code 02 (Telehealth) listed as an allowable POS. Effective January 1, 2022, if POS code 02 is not listed as an allowable POS for a procedure code, the service will not be reimbursed under permanent telehealth policy.

Claims for telehealth services must include all modifiers required by coverage policy, in addition to POS code 02 and the GT modifier, in order to reimburse the claim correctly.

County-administered programs, school-based services, and any other programs that utilize cost reporting must include required modifiers, such as renderer credentials and group versus individual services, as well as correct details for cost reporting to ensure correct reimbursement.

Note: The GT modifier may not be listed on the fee schedule, but it is still required on all claim submissions that use POS code 02 to indicate the telehealth service was performed synchronously.

Topic #21097

Drugs for Tobacco Cessation

BadgerCare Plus, Medicaid, and SeniorCare cover legend drugs for tobacco cessation.

BadgerCare Plus and Medicaid also cover OTC nicotine gum, patches, and lozenges.

A written prescription from a prescriber is required for both federal legend and OTC tobacco cessation products. Prescribers are required to indicate the appropriate diagnosis on the prescription. PA is required for uses outside the allowable ICD diagnoses included in the table below.

Allowable ICD Diagnosis Codes Descriptions
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.203 Nicotine dependence, unspecified, with withdrawal
F17.208 Nicotine dependence, unspecified, with other nicotine-induced disorders
F17.209 Nicotine dependence, unspecified, with unspecified nicotine-induced disorders
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.213 Nicotine dependence, cigarettes, with withdrawal
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.223 Nicotine dependence, chewing tobacco, with withdrawal
F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders
F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
F17.293 Nicotine dependence, other tobacco product, with withdrawal
F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders
F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders
Z72.0 Tobacco use
Topic #6177

Tobacco Cessation Drugs and Services

Under the outpatient mental health benefit, BadgerCare Plus and Wisconsin Medicaid cover medically necessary diagnostic evaluations and psychotherapy related to tobacco cessation provided by psychiatrists, Ph.D. psychologists, and Master's-level therapists.

BadgerCare Plus and Wisconsin Medicaid cover psychotherapy on an individual and group basis.

Tobacco cessation services, as preventive services with an A or B rating from the USPSTF, do not require copayments from any member enrolled in BadgerCare Plus or Medicaid. SeniorCare members are not exempt from copayment for tobacco cessation services.

 
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