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Medicaid & Medicare

Medicaid covers the following FDA-approved prescription medications, for a 30-day supply only:

  • Bupropion SR (marketed as Zyban)
  • Nicotine inhaler (Nicotrol)
  • Nicotine nasal spray (Nicotrol)
  • Nicotine patch
  • Varenicline (Chantix)
  • Combination therapy: Nicotine replacement therapy and Zyban; or nicotine patch and other nicotine replacement therapy

Note: Repeated courses of treatment are allowable, as long as they are consistent with FDA-approved use of smoking cessation prescription medications. Health care providers must certify in their own handwriting on the prescription or attachment, “recipient is enrolled in a physician-supervised behavioral program for nicotine adhesive patches, gum and nasal spray.”

Know the Codes: Physicians and other Certified Medicaid Providers should use appropriate ICD-9 diagnostic code and select the appropriate billing code for services rendered.

Medicare Reimbursement

Health care providers should indicate ICD-9 diagnostic code 305.1 Tobacco Use Disorder.

The billing code for counseling treatment is: G0376 (over 10 minute counseling session) or G0375 (3-10 minute counseling session).

A cessation counseling attempt includes:
1. Up to 4 cessation counseling sessions (1 attempt = up to 4 sessions)
2. Two cessation counseling attempts (or up to 8 cessation counseling sessions) are allowed every 12 months.

A cessation counseling session refers to face-to-face patient contact of either:
1. Intermediate (greater than 3 minutes up to 10 minutes); or
2. Intensive (greater than 10 minutes)

Cessation counseling sessions may be performed “incident to” the services of a qualified practitioner. During a 12-month period, the practitioner and the beneficiary have flexibility to choose between intermediate or intensive counseling strategies for each session.

Covered Medications: Every drug plan is required by Medicare to cover at least one of the following FDA-approved medications:
  • Bupropion SR (marketed as Zyban and Wellbutrin and also available generically)
  • Nicotine inhaler (Nicotrol)
  • Nicotine nasal spray (Nicotrol)
  • Nicotine patch (if prescription)
  • Varenicline (Chantix)

Please verify with Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug Plan Formulary.

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Share Your Quit Story

Everyone's quit story is different. What works for one, might not always work for another. So we want you to share your success story (and your struggles) with us, so that you can help motivate and encourage others to quit.

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