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Medicaid Tobacco Cessation Program

As of Sept. 1, 2010, tobacco cessation medication and/or nicotine replacement therapy is available to Kentucky Medicaid members who use tobacco products. Dual-eligible members may be eligible to receive some of the available medicines to help them quit using tobacco. Members enrolled in a Managed Care Organization (CoventryCares of Kentucky, Humana Caresource, Kentucky Spirit Health Plan, Passport Health Plan or WellCare of Kentucky) should contact those organizations for the details of their tobacco cessation program.

How do I apply?

A referral is required from a licensed Kentucky Medicaid physician, nurse practitioner or physician assistant to receive tobacco cessation Medicaid benefits. A prescription is needed for all tobacco cessation medications, including over-the-counter nicotine replacement products. No copayment is required for these medications. All FDA-approved medications are covered for two 90-day treatment regimens per year. Some products are not preferred and will require review via the prior authorization process. In addition, all refills require approval through the Department for Medicaid Services, Division of Medical Management.

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What is the process?

Tobacco cessation assessment take a minimum of 10 minutes, is performed face to face and must include: asking the patient about tobacco use; advising the patient to quit; and assessing the patient's readiness to quit. If the assessed member's readiness to quit occurs during a regular office visit, the tobacco cessation counseling can be billed separately using CPT Code 99407. The assessment must include history of tobacco use, medical and psychosocial history, review of coping skills and barriers to quitting and a written referral (Tobacco Cessation Referral Form) to a cessation program.

The provider is required to complete a Tobacco Cessation Referral Form signed by the provider and member affirming the member's intent to quit using tobacco. The provider submits the Tobacco Cessation Referral Form to Medicaid by fax or mail per instructions on the form.

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Where do I go for more information?

For more information, call Kentucky Medicaid at (888) 564-3476. If you are assigned to CoventryCares of Kentucky, Humana CareSource, Kentucky Spirit Health Plan, Passport Health Plan or WellCare of Kentucky, call the number on the back of your membership card to find out about their tobacco cessation program.

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Last Updated 10/8/2013
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