Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Outpatient Mental Health | 02/16/2025 | Covered and Noncovered Services : Covered Services and RequirementsTopic #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. 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 |
|