Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

1)    QualChoice offers a smoking and tobacco cessation program, “Kick The Nic”, that allows the member two attempts to quit smoking or tobacco use per year.

2)    Smoking and tobacco cessation services are not offered in all products.  Refer to your Explanation of Coverage, Certificate of Coverage, Summary Plan Description, or Benefit Summary for coverage.

1)    For plans that have a smoking and tobacco cessation benefit, the QualChoice Smoking Cessation program allows the member up to 2 attempts to quit tobacco use per year. 

2)    Nicotine replacement therapy (NRT) as well as other drugs (e.g. varenicline, bupropion) used to treat smoking and tobacco cessation are covered under the pharmacy benefit.

When billing for tobacco cessation, please review the following:

a)    Codes utilized for the tobacco cessation visit require preauthorization:

i)      99406 - Intermediate tobacco cessation counseling (3 to 10 minutes).

ii)     99407 - Intensive tobacco cessation counseling (greater than 10 minutes).

b)    Documentation should include the amount of time spent with the patient along with the assessment.   Typically included in the assessment documentation are the following components:

i)      Ask about tobacco use

ii)     Advise the patient to quit

iii)   Access the willingness to attempt to quit

iv)   Assist with the attempt to quit

c)    The CPT code book has a category II classification system listing “F” codes that may be used to capture additional data to support quality performance measures. The “F” codes may be used in conjunction with an E&M visit to indicate clinical components of the E&M services.   These codes are used to supplement your documentation by describing clinical services or results, but are not intended to replace category I codes.

i)      1000F -Patient History- tobacco use assessed 

ii)     4000F -Tobacco use cessation counseling

iii)   4001F- Tobacco use cessation intervention, pharmacologic therapy

Codes Used In This BI:

1000F             Patient History- tobacco use assessed 

4000F             Tobacco use cessation counseling

4001F             Tobacco use cessation intervention, pharmacologic therapy

99406             Intermediate tobacco cessation counseling (3 to 10 minutes)

99407             Intensive tobacco cessation counseling (greater than 10 minutes)

Minimal cessation counseling of less than 3 minutes is not separately billable and should be considered a part of the evaluation and management visit.

Addendum:

Effective 06/01/2023: Updated to reflect coverage of NRT products and other drugs under pharmacy benefit.