Quit Tobacco Series Fact Sheet #3: Medicaid / BadgerCare
Medicaid/BadgerCare coverage for tobacco-dependence treatment applies to treatment provided by any Medicaid-certified Wisconsin physician, nurse practitioner or physician assistant.
Did You Know?
The smoking rate among Wisconsin Medicaid adult members is almost double the general population.
Coaching on how to quit—combined with medication—can quadruple the chances of quitting smoking.
Medicaid/BadgerCare covers the following FDA-approved medications:
Bupropion SR: Zyban, Wellbutrin or generic
Nicotine lozenge: Over-the-counter
Nicotine inhaler: Nicotrol
Nicotine nasal spray: Nicotrol
Nicotine patch: Over-the-counter or prescription
Nicotine gum: Over-the-counter
Combination therapy: E.g., nicotine patch + lozenge
Repeated courses of treatment are allowed. All require a written prescription by a Medicaid-certified provider (includes a physician, nurse practitioner, physician assistant or dentist).
None for tobacco cessation. Per the Affordable Care Act, essential health benefits are to be provided without cost to the patient.
Know the Codes
Evaluation & Management (E&M) visits for the sole purpose of tobacco-dependence treatment are covered and do not require prior authorization for reimbursement. Services may be provided by ancillary staff (e.g., staff nurse) if under direct supervision of a physician. Medicaid reimburses these services when billed by a supervising physician. Exclusions: Group therapy, telephone and web-based counseling are NOT covered. Counseling is NOT reimbursed for dentists or dental hygienists.
The Wisconsin Tobacco Quit Line is free and available to assist all Wisconsin residents who want to quit: 800-QUIT-NOW (800-784-8669); Available 24/7.
|HMO Ombudsperson & Contract Monitors||800-760-0001|
|Automated Voice Response System||800-947-3544|
|Wisconsin Medicaid Senior Care Member Services||800-657-2038|
|Medicaid & Badgercare HMO Member Services|
|Blue Cross Blue Shield (formerly CommunityConnect)||800-362-3002|
|Children's Community Health Plan||800-482-8010|
|Dean Health Plan (Dane County)||800-279-1301|
|Dean Health Plan (Milwaukee and surrounding counties)||800-482-8010|
|Group Health Cooperative of Eau Claire||888-203-7770|
|Group Health Cooperative of South Central Wisconsin||608-828-4853|
|Gundersen Health Plan||866-537-1477|
|Health Tradition Health Plan||800-545-8499|
|Managed Health Services||888-713-6180|
|MercyCare Insurance Company||800-895-2421|
|Network Health Plan||888-713-6180|
|Physicians Plus Insurance Corporation||800-545-5015|
|Security Health Plan||8007913044|
|Trilogy Health Insurance||866-429-3241|
|UnitedHealthcare of Wisconsin||800-504-9660|
|Unity Health Plans||800-362-3310|