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Medicaid & Tobacco Dependence Treatment Mental Health and Substance Abuse

Medicaid & Tobacco Dependence Treatment Mental Health and Substance Abuse. Adult smoking among Medicaid recipients is 50 percent higher than the adult population as a whole. Individuals with a psychiatric diagnosis consume 45 percent of the cigarettes in the U.S. 80 percent of alcoholics smoke.

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Medicaid & Tobacco Dependence Treatment Mental Health and Substance Abuse

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  1. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse • Adult smoking among Medicaid recipients is 50 percent higher than the adult population as a whole. • Individuals with a psychiatric diagnosis consume 45 percent of the cigarettes in the U.S. • 80 percent of alcoholics smoke.

  2. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse • Medicaid now covers all prescriptions and tobacco cessation services*. • Under the outpatient substance abuse benefit, Medicaid covers medically necessary substance abuse counseling services related to tobacco cessation on an individual or group basis, provided by physicians, Ph.D psychologists and substance abuse counselors (including masters level therapists). • Under the outpatient mental health benefit, Medicaid covers medically necessary diagnostic evaluations and psycho-therapy related to tobacco cessation provided by psychiatrists, Ph.D. psychologists, and master's level therapists. 

  3. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse • Wisconsin Medicaid now covers combination therapy for smokers (more than one medication used at the same time, like bupropion plus the nicotine inhaler). For more details, refer to Medicaid publications at www.dhfs.wisconsin.gov/medicaid. * Mental health patients who have been transferred to Medicare Part D may have coverage different from those receiving Medicaid benefits.

  4. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse Reimbursement • Substance abuse or mental health services provided for the sole purpose of tobacco cessation do not require prior authorization for reimbursement unless services exceed 15 hours or $500, whichever comes first. • For outpatient substance abuse treatment services, use the ICD-9 code (305.1) plus HCPCS codes  H0005, H0022, H0047, or T1006 with the appropriate professional modifiers.*  • For outpatient mental health services, use ICD-9 code (305.1) plus one of the CPT codes 90804 through 90899 with the appropriate professional modifiers.*

  5. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse • Telephone and web-based counseling are not covered. • * Refer to Medicaid publications for Medicaid's coverage policies, including prior authorization, at www.dhfs.wisconsin.gov/medicaid

  6. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse Covered Medications • Medicaid, BadgerCare & SeniorCare cover the following: • Bupropion SR • Varenicline (Chantix) • Nicotine replacement therapy—the inhaler, nasal spray and patch (written as “legend nicotine patch”) • Combination therapy (more than one medication at one time): nicotine patch and another nicotine-replacement therapy, for example.

  7. Medicaid & Tobacco Dependence TreatmentMental Health and Substance Abuse Questions? Go to www.dhfs.wisconsin.gov/medicaid

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