A new law passed in the final days of the 2017 legislative session will ensure patients who want to quit smoking will have access to treatments their physicians prescribe.
In the past, KMA members reported widespread barriers related to tobacco screening and cessation treatments. The problems persisted even after the Affordable Care Act was implemented; tobacco cessation coverage continued to vary by insurer with no consistency, burdensome prior authorizations and gaps in coverage.
One of the most common complaints was that not all insurers covered all Current Procedural Terminology (CPT) codes used for tobacco-use cessation counseling. This was due, primarily, to Kentucky Regulation (907 KAR 3:215), which was implemented many years ago and only required coverage for one CPT code (99407).
Senate Bill 89, sponsored by Sen. Julie Raque Adams of Louisville, eliminates those barriers. Gov. Matt Bevin signed the critical bill, which expands tobacco screening and cessation coverage to include all forms of tobacco cessation services recommended by the U.S. Preventive Services Task Force. The new law takes effect 90 days after the end of the 2017 regular session. The covered services, and their codes, include:
99406: Smoking and tobacco use—cessation counseling-intermediate greater than three minutes up to 10 minutes.
99407: Smoking and tobacco use—cessation counseling visit, intensive greater than 10 minutes.
99078: Group health education to discuss smoking and tobacco cessation. This code has historically been used to provide diabetic instructions, obesity or prenatal counseling.
For more information on this subject—including 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.
