SoonerCare Tobacco Cessation Benefit

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Research indicates that no other clinical intervention can reduce illness, prevent death, or increase quality of life more effectively than tobacco cessation. That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products. SoonerCare will reimburse providers who use the “5As” approach to tobacco cessation developed by the Agency for Healthcare Research and Quality and endorsed by the U.S. Public Health Service.

What are the “5As”?

  • Ask – the member to describe their tobacco use, ideally at every visit
  • Advise – the member to quit
  • Assess – the willingness of the member to quit
  • Assist – the member with referrals and plans to quit
  • Arrange – for a follow up with the member 

Who is Qualified to Receive This Benefit?

SoonerCare members who use tobacco age 12 and over.

Who Can Perform the “5As”?

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Nurse Midwives
  • OSDH Nurse Practitioners & Registered Nurses
  • FQHC Nurse Practitioners & Registered Nurses
  • Dentists 

What Must a Compensable Service Include?

  • A separate progress note with member specific information addressing the “5As” counseling. OHCA CH-18 Form can be used or the physician can choose to use his/her own clinical notes.
  • Beginning and ending times performing the service and signature with credentials of the direct service provider.

What Tobacco Cessation Products are Covered?

In an effort to reduce barriers to tobacco cessation coverage, effective September 1, 2014, the Oklahoma Health Care Authority (OHCA) has removed prior authorization, co-pays and duration limits for the following tobacco cessation products:  

  • Patches
  • Gum
  • Lozenges
  • Nasal Spray
  • Inhaler
  • Zyban or available generic
  • Chantix or available generic (180 days per 12 months)

Over-the-counter products are covered but require a prescription.

Coding and Limits

  • Tobacco cessation counseling services are paid in addition to other medically necessary services rendered on the same day
  • Use code 99406 for a three to 10 minute counseling session
  • Use code 99407 for a 10 or more minute counseling session
  • Dental code is D1320
  • No billing allowed for less than three minutes
  • SoonerCare members are qualified for a total of eight counseling sessions per rolling calendar year

SoonerCare Resources

External Resources

  • Oklahoma Tobacco Helpline – 1-800-QUIT-NOW 
    The Oklahoma Tobacco Helpline website offers tips on helping people wherever they are in the quit process (Thinking about quitting/Ready to quit/Help someone quit/Stay tobacco free). Oklahomans are also able to enroll in 1-800-QUIT-NOW free coaching calls from this website.     
  • Order free promotional materials from the Oklahoma Tobacco Helpline
  • Quit Now
    Patients can use this website to enroll online in the Oklahoma Tobacco Helpline.
  • Become an Ex 
    TheEX Plan is a free quit smoking program, one that can show you a whole new way to think about quitting. It’s based on personal experiences from ex-smokers as well as the latest scientific research from the experts at Mayo Clinic.
  • Tobacco Stops With Me
    A website for providers and Oklahomans wanting to quit tobacco. Includes the latest news/facts/resources about tobacco,  and what is tobacco cessation efforts are happening all around Oklahoma. It also contains a section on peoples stories of how tobacco has affected them and their family.
  • Guide to Quitting Smokeless Tobacco 
    The American Cancer Society offers resources to learn more about the dangers of smokeless tobacco and tips to help you quit. 
  • Oklahoma State Department of Health – Tobacco Prevention Programs
    This website has a breakdown of the Tobacco Use Prevention and Reduction Programs and contains links to all the different programs and opportunities around the state.   
  • Breathe Easy
    This website contains information on the breathe easy initiative/smoke free policy. You can go on there and order decals to put up to promote a smoke free business or home.
  • Smokefree Women 
    This website includes a variety of interactive tools to help women quit smoking, with a whole section dedicated to pregnant tobacco users.