Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Physician | 02/16/2025 | Covered and Noncovered Services : Covered Services and RequirementsTopic #494 Tobacco Cessation Drugs and Services
Tobacco cessation services are reimbursed as part of an E&M office visit provided by a pharmacist, physician, physician assistant, nurse practitioner, and ancillary staff. Services must be one-on-one, face-to-face between the provider and the member. ForwardHealth does not cover group sessions or telephone conversations between the provider and member under the E&M procedure codes.
Tobacco cessation services covered under ForwardHealth include outpatient substance abuse services or outpatient mental health services, as appropriate.
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.
Ancillary staff can provide tobacco cessation services only when under the direct, on-site supervision of a Medicaid-enrolled physician. When ancillary staff provide tobacco cessation services, Wisconsin Medicaid reimburses up to a level-two office visit (CPT procedure code 99212). The supervising provider is required to be listed as the rendering provider on the claim.
Pharmacists can provide tobacco cessation services within their scope of practice. This includes the following CPT codes:
- 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.
- 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.
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 |
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