Tobacco Cessation Coverage
Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) is enhancing tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention (CDC) and the American Lung Association (ALA). This update applies to both the fee-for-service and managed care Medicaid benefits.
The following medications will be available without prior authorization or co-payment when prescribed by a Medicaid provider:
- Bupropion for tobacco use
- Nicotine gum
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine inhaler
- Nicotine patch
One-on-one telephone and web-based counseling are available to Medicaid beneficiaries without charge through the SC Tobacco Quitline. SCDHHS strongly encourages prescribers and pharmacists to refer patients to the Quitline at 1-800-QUIT-NOW. Additional information is available at http://www.scdhec.gov/Health/TobaccoCessation/HelpYourPatientsQuit/.
Additionally, tobacco cessation counseling in individual and group settings will be covered when billed with Current Procedural Terminology (CPT) codes 99406 and 99407. Reimbursement for counseling is limited to four sessions per quit attempt for up to two quit attempts annually.
Please refer any questions or concerns regarding this bulletin to the Provider Service Center at (888) 289-0709.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.