Reimbursement

MEDICARE COVERS MEDICATION & COUNSELING FOR TOBACCO CESSATION

Healthcare Providers should indicate ICD-9 diagnostic code 305.1 Tobacco Use Disorder.

The billing code for counseling treatment is: G0376.

Cessation Counseling
A cessation counseling attempt includes:
-Up to 4 cessation counseling sessions (1 attempt = up to 4 sessions)
-Two cessation counseling attempts (or up to 8 cessation counseling sessions) are allowed every 12 months.

Cessation counseling session refers to face-to-face patient contact of either:
- intermediate (greater than 3 minutes up to 10 minutes); or 
- intensive (greater than 10 minutes).

Cessation counseling sessions may be performed "incident to" the services of a qualified practitioner. During a 12-month period, the practitioner and the beneficiary have flexibility to choose between intermediate or intensive counseling strategies for each session.

Covered Medications
Every drug plan is required by Medicare to cover at least one of the following FDA-approved medications:
-Bupropion SR (marketed as Zyban and Wellbutrin and also available generically)  
-Nicotine inhaler (Nicotrol)
-Nicotine nasal spray (Nicotrol)
-Nicotine patch (if prescription)

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Medicaid Information
Fax-to-Quit Louisiana