Beginning January 1, 2014, the Alabama Medicaid Agency will cover a new smoking cessation benefit for Medicaid-eligible pregnant women.  Medicaid will reimburse for up to four face- to-face counseling sessions in a 12-month period.  The reimbursement period will begin in the prenatal period and continue through the postpartum period (60 days after delivery or pregnancy end).  Documentation must support each counseling session. 

Additional information regarding this mandate can be accessed at http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD11-007.pdf. 

Alabama Medicaid Policy: 

Face-to-face counseling services must be provided:

·         By or under the supervision of a physician; or

·         By another health care professional who is legally authorized to furnish such services under State law within their scope of practice and who is authorized to provide Medicaid covered services other than tobacco cessation services

The following CPT Codes are applicable:

·         99406—Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes

·         99407—Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

The following diagnosis codes must be billed on the claim (UB-04 or CMS-1500 claim form) in order to be reimbursed by Medicaid:

V220-V222—Normal pregnancy

V230-V233—Supervision of high-risk pregnancy

V2341-V237—Pregnancy with other poor obstetric history, or

V242—Routine postpartum follow-up

AND

3051—Tobacco use disorder

Pharmacies must bill for these specific services through their DME NPI.