Confusion Persists Regarding Tobacco Cessation and Counseling Coverage

Posted December 17, 2018

In 2017, a new law was passed that ensured patients who want to quit smoking will have access to treatments and tobacco aids their physicians prescribe. After more than a year, confusion about what is covered persists.

This is primarily because Kentucky regulation offers broader coverage that applies to Medicaid, Medicaid Managed Care Originations (MCOs) and fully-funded health benefit plans while it does not apply to Medicare, Medicare Advantage, Tri-Care and self-funded health plans.

Medicare is a federally funded program, and while some type of tobacco cessation and counseling is provided, it might not be as comprehensive as the tobacco treatment coverage in Kentucky.

For example:

  •  Medicare offers two cessation attempts per year, while the Kentucky program offers unlimited attempts (although Kentucky requires a prior-authorization after two attempts)
  • Kentucky allows nicotine replacement therapy over the counter while Medicare does not

Read more on Medicarecoverage.

For more information on this subject and to receive a copy of the KMA educational PowerPoint, “No Butts About It –Tobacco Screening and Cessation,” which includes information on the hierarchy of ICD-10 coding for tobacco screening and cessation, contact Lindy Lady at lady@kyma.org.