Expansion of Smoking Cessation Counseling to ALL Medicaid Beneficiaries
Effective April 1, 2011
Medicaid expanded coverage of smoking cessation counseling (SCC) to ALL Medicaid beneficiaries.
- Each Medicaid beneficiary will be allowed six counseling sessions during any 12 continuous months which must be provided on a face-to-face basis.
- Smoking cessation counseling complements the use of prescription and non-prescription smoking cessation products. These products, both prescription and non-prescription are also covered by Medicaid, however providers must give the Medicaid recipients prescriptions for all the FDA approved cessation medications.
Smoking cessation counseling services are reimbursable when provided by the following provider types:
- Office-based practitioners (physicians, registered nurse practitioners [RNP],and licensed midwives [LM]);
- Article 28 hospital outpatient departments (OPD), free-standing diagnostic and treatment centers (D&TC) and federally qualified health centers (FQHC) including FQHC school based health centers (SBHC) that bill using Ambulatory Patient Groups (APGs).
Reimbursement for smoking cessation counseling (SCC) must meet the following criteria:
- SCC must be provided face-to-face by a physician, registered physician assistant, registered nurse practitioner (RNP), or licensed midwife (LM) either with or without an Evaluation and Management procedure code.
- SCC may take place during individual or group counseling sessions. Group sessions will be reimbursable effective June 1, 2011, for office-based practitioners and July 1, 2011, for Article 28 clinics.
- Each Medicaid beneficiary will be allowed six counseling sessions during any 12 continuous months; including any combination of individual or group counseling sessions.
- Claims for SCC must include the appropriate SCC CPT Procedure Code. Only one procedure code per day may be billed.
- 99406 – Intermediate SCC, 3 to 10 minutes (billable ONLY as an individual session)OR
- 99407 – Intensive SCC, greater than 10 minutes (billable as an individual or group session; using the ‘HQ’ modifier to indicate a group SCC session, up to eight patients in a group).
- Claims must include ICD-9-CM diagnosis code, 305.1 tobacco use disorder.
Source:
New York State Medicaid Update. The Official Newsletter of the New York Medicaid Program. (April 2011). Volume 27: Number 5. www.health.ny.gov
