Good News – Medicaid Now Pays for Tobacco Cessation Counseling

Effective January 1, 2014, Medicaid began reimbursing providers for tobacco cessation counseling services for all Medicaid members. DCH encourages all providers enrolled in the EPSDT (Health Check) Program to provide tobacco cessation counseling services during preventive and interperiodic EPSDT visits as appropriate. Two procedure codes are available for billing by EPSDT providers and both require EP modifier. The codes are:

99406 EP – Smoking and tobacco use intermediate counseling,greater than 3 minutes up to 10 minutes

99407 EP – Smoking and tobacco use intensive counseling, greater than 10 minutes

Tobacco cessation counseling must be rendered during a face-to-face encounter with the member for the purpose of promoting healthy habits. Prescribing pharmacotherapy medication is not a prerequisite for use of these procedure codes. Only two 12-week tobacco cessation treatment periods will be allowed per member per year. The provider must document the services in the member’s medical record every 30 days during the 12-week treatment period. Pharmacotherapy medication is also covered. Please refer to the Pharmacy Services Manual for detailed information on the covered medications and prior authorization procedure.

Tobacco cessation interventions, including counseling and medications, have been found to be among the most effective preventive services. DCH aims to reduce tobacco use, improve health, and reduce costs atributable to smoking-related health conditions. DCH annually reports to CMS the state’s progress in providing medical assistance with smoking and tobacco use cessation. DCH reports the percentage of providers who: advise smokers and tobacco users to quit; discuss or recommend cessation medications; and discuss or provide cessation methods or strategies for smokers and tobacco users.

Medicaid members may also be referred to the Georgia Quit Line at 1-877-279-STOP (7867). The Georgia Quit Line provides free counseling, a resource library, and support and referral services for tobacco users ages 13 and older. Callers have the opportunity to speak with health care professionals who develop a unique plan for each individual.