| Insurance Company |
Education Coverage |
Pharmaceuticals |
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- Reimbursement to providers up to four (4) visits within a one year time period for formal smoking cessation program using procedure code S9075. Trained educators must be supervised by a participating provider.
- Each session will consist of a minimum of 10 minutes person-to-person counseling by the provider/trained educator.
- Benefits will be provided for up to four visits per year up to a maximum of three consecutive or non-consecutive years.
- Refer to their policy for more specifics regarding policy considerations, exclusions and other health plans they offer.
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- Benefits will be provided only if the member has a CDPHP Prescription Drug Rider.
- Benefits will be provided only for smoking cessation agent that requires a prescription, including but not limited to: Nicotine nasal spray, inhalers and Zyban. Refer to the CDPHP policy for further specifics prior to ordering.
- No benefits are available for any over-the-counter smoking cessation agent.
- Chantix is a Tier 3 (higher co pay)
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- Patient will be reimbursed for cessation program that is on their list of approved courses.
- Patient needs to identify the program and submit specific information to obtain reimbursement. Refer to policy provided by BSNENY for further specifics.
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- If you participate in a smoking cessation course you will be eligible for coverage of Zyban
- Most members can get reimbursed for a 12-week supply of Smoking Cessation Aids for one smoking cessation attempt a year. (Nicotine patch, gum, lozenge, nasal spray and Zyban)
- Upon their provider’s approval, they may get reimbursed for more than one product at a time.
- Refer to policy for further specifics.
- Chantix is a Tier 3 (higher co pay)
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- MVP has implemented a new program “I Aim To Quit” effective July 2004.
- Members will be required to sign the MVP “I Aim To Quit” agreement and compete a Questionnaire.
- www.mvphealthcare.com is the site to obtain these documents along with more specific information.
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- Members with a prescription drug benefit are eligible for this program
- They will be provided coverage for a three-month supply of Zyban if meet the requirements.
- OTC NRT is out of pocket.
- For further information call 1-888-687-6277
- Covers Chantix if you have a rider, most patients have tier 3.
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- There are various free smoking cessation programs available to Medicaid patients
- Have patient contact their Medicaid Department for details.
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- The nicotine replacement products covered are the patch, gum, inhalers and nasal spray. Some of these are prescription and some are over-the-counter.
- Zyban is a non-nicotine prescription product that is covered.
- Chantix is covered with a $3 co-pay
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PPO guidelines are contract specific and benefits may be obtained via website entering patient’s identification number. HMO payment guidelines refer to www.ghi.com for specifics.
Coverage will be provided for a maximum of 8 counseling services/visits per year and will be reimbursed using code S9453 < |
Coverage will be provided for those member with a prescription drug rider for two courses of smoking cessation therapy per person per year, as medically necessary. For more details, refer to web site on medication reimbursement. |
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Quality Incentive Program / Description of Measures
Members 12-21 years of age during the reporting year who were screened/counseled for tobacco use during the reporting year.
V65.42 for tobacco use screening/counseled |
No Information |
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Non-covered service |
No Information |
Wellcare |
No information |
- Smoking Cessation is a covered benefit for all product lines. Child Health Plus, Family Health Plus, WellCare Healthy Choice, and WellCare Choice.
- Members can get 3 months of smoking cessation products (nicotine patches or Zyban) per calendar year. However, WellCare Healthy Choice members must use their Medicaid card for pharmacy benefits.
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