Tobacco Cessation Coding And Billing
Vermont Medicaid covers tobacco treatment reimbursement for your practice. Coverage includes up to 16 face-to-face tobacco cessation counseling sessions per calendar year for eligible members of any age who use tobacco (adult and youth cessation).
This coverage applies to brief or intermediate counseling, in person or during a telehealth session, and when furnished by (or under the direction of) a physician or by any other health care professional who is legally authorized to furnish such services under state law and licensure. Medicaid reimbursement also covers “Qualified” Tobacco Cessation Counselors (requires at least eight hours of training in tobacco cessation services from an accredited institute of higher education).
Tobacco Cessation CPT and CDT Codes with Definitions
The following medical codes correctly capture the diagnosis for tobacco cessation counseling and allow your practice to bill Medicaid. These smoking cessation CPT and CDT counseling codes apply to all forms of tobacco cessation.
Medical Practice Codes
- 99406: Smoking and tobacco use cessation counseling visit; immediate greater than 3 minutes up to 10 minutes
- 99407: Smoking and tobacco use cessation counseling visit, intensive greater than 10 minutes
- 99407HQ: Smoking and tobacco use cessation counseling visit, intensive greater than 10 minutes, Group Session
- Asthma- and Tobacco-Related Billing and Reimbursement Recommendations (PDF)
Dental Practice Code
- D1320: Smoking and tobacco use cessation counseling visit, for the control and prevention of oral disease
Refer Your Patient
If your patient is ready to get started, they can: Medicaid members and uninsured Vermonters who want to quit tobacco can now earn up to $150 by enrolling in 802Quits. Refer patients for free counseling, quit medication and more.
Or, you can send a referral electronically during the appointment.
Medicaid Benefits
In Vermont, Medicaid members qualify for tobacco cessation as a preventive service.