Insurance Coverage and Billing

State law requires health plans to cover the same preventive services required by federal law in 2016, which include tobacco cessation services, as outlined in Affordable Care Act implementation guidance.

This means that – in addition to screening for tobacco use – providers should be able to bill for the following services without prior authorization and cost to their client, at least twice per year, per client:

  • Four counseling sessions, lasting at least 10 minutes, delivered:
    • Individually, face-to-face (e.g., CPT code 99407)
    • Individually, over the phone (see Washington State Quitline)
    • In a group setting (see Freedom From Smoking)
  • A 90-day supply of medications approved by the FDA for tobacco cessation:
    • Over-the-counter (OTC) nicotine replacement therapy (NRT), including the patch, gum, and lozenge
    • Prescription NRT (inhaler and nasal spray)
    • Prescription non-nicotine medication (bupropion and varenicline).

Health plans may require a prescription to reimburse clients for OTC NRT. Consider combining use of nicotine gum or lozenges (short-acting) with nicotine patches (long-acting) to triple your clients' chances of quitting.

Results from a 2019 survey of insurance carriers in Washington state suggest that:

  • All privately-insured clients and 1 in 3 Medicaid clients have coverage for individual, face-to-face counseling;
  • Most privately-insured clients and all Medicaid clients have coverage for phone counseling;
  • Nearly all privately-insured clients and 1 in 8 Medicaid clients have coverage for group counseling;
  • All Medicaid clients and most privately-insured clients have coverage for OTC NRT (patch, gum, and lozenge);
  • All privately-insured clients and most Medicaid clients have coverage for prescription NRT (inhaler and nasal spray);
  • All privately- and publicly-insured clients have coverage for bupropion and varenicline.

Medicare clients have coverage for face-to-face counseling and prescription NRT and non-nicotine medication, but can receive free OTC NRT through the Washington State Quitline. For clients with Apple Health (Medicaid), confirm coverage with your clients' managed care plan or the latest fee-for-service physician-related/professional services billing guide. Still, coverage barriers – such as stepped-care therapy and quantity limits – often apply, so when in doubt or short on time, refer your clients to the Washington State Quitline.

If you find a health plan that does not cover tobacco cessation services for their members, visit the Office of the Insurance Commissioner .

See Commercial Tobacco Use and Dependence Treatment in Washington State for more information.