CODING AND BILLING

As of January 1, 2014, Vermont Medicaid covers up to 16 face-to-face tobacco cessation counseling sessions per calendar year for eligible members of any age who use tobacco. This coverage applies 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. “Qualified” Tobacco Cessation Counselors are also allowed (requires at least eight hours of training in tobacco cessation services from an accredited institute of higher education).

Codes with Definitions

Use the following medical codes to correctly capture the diagnosis for tobacco and bill smoking and tobacco cessation counseling.

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

D1320

Smoking and tobacco use cessation counseling visit, for the control and prevention of oral disease

Medicaid Benefits

In Vermont, Medicaid members qualify for tobacco cessation as a preventive service.