SoonerCare Tobacco Cessation Benefit
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?
Most SoonerCare members who use tobacco age 12 and over.
Who Can Perform the “5As”?
- Physicians
- Physician Assistants
- Nurse Practitioners
- Nurse Midwives
- Oklahoma State Health Department of Health Nurses
- Federally Qualified Health Centers
- 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?
SoonerCare offers members a 90-day prescription coverage for tobacco cessation products. Coverage beyond 90 days requires a prior authorization and proof of enrollment in a behavior modification program. One example of a behavior modification program would be to register with the Oklahoma Tobacco Helpline by calling 1-800-QUIT-NOW.
- Patches
- Gum
- Lozenges
- Nasal Spray
- Inhaler
- Zyban or available generic
- Chantix or available generic
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
- A member is qualified for a total of 180 days of tobacco cessation products in a 365 day calendar year. After the member has had 180 days of treatment, there is a 180 day waiting period before tobacco cessation products can be covered again.
Forms
Resources
For more information about this benefit, call the Child Health Line (405) 522-7188.