Tobacco Cessation for Pregnant Women

Effective with dates of service on or after February 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will cover Tobacco Cessation treatment for all pregnant women in accordance with Section 4107 of the Affordable Care Act, which amended Section 1905 (bb)(2) of the Social Security Act. For the complete policy and billing instructions, please review the Physician, Laboratories and Other Medical Professionals manual located on the SCDHHS website at www.scdhhs.gov.

The tobacco cessation policy for pregnant women will cover two (2) quit attempts per fiscal year, counseling, and pharmacotherapy. Providers may bill the Current Procedure Terminology (CPT) codes 99406 and 99407 for the counseling services. SCDHHS will cover four (4) counseling sessions per quit attempt. SCDHHS currently reimburses for the following pharmaceuticals used to facilitate the discontinuation of tobacco products:

  • Bupropion sustained release products
  • Chantix® (varenicline) tablets
  • Nicotine Replacement Therapy (NRT) pharmaceutical products: legend and over-the-counter patches and gum. (NRT lozenges, inhalers and sprays are non-covered unless approved through the prior authorization process.)

Beneficiaries may also access the South Carolina Department of Health and Environmental Control (SCDHEC) quit line. The quit line may be utilized by having the beneficiary call 1-800-QUIT-NOW (1-800-784-8669), (this is a toll free call); or they may go to the quit line web page at www.scdhec.gov/quitforkeeps.

SCDHHS policy requires that all tobacco cessation treatment must be ordered by a qualified practitioner defined as a physician, nurse practitioner, certified nurse midwife, or physician assistant. Medical documentation such as time spent counseling the patient, treatment plan, and pharmacotherapy records must be maintained in the patient’s chart.

This bulletin affects all fee-for-service beneficiaries that are not assigned to a Medical Home Network (MHN). All MHNs and Managed Care Organizations (MCOs) are subject to the policy outlined by the Managed Care program. Please contact the appropriate MCO or MHN for any questions or concerns regarding tobacco cessation.

Your continued support of the South Carolina Healthy Connections Medicaid Program is appreciated. Any questions regarding this bulletin should be directed to the Program Manager in the Office of Physician, Pharmacy, and Enhanced Care Services at (803) 898-2660.

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