Billing and Funding Considerations

Tobacco treatment services can be billed to insurance and are covered by Medicare and Medicaid.

Although the level of reimbursement for providing smoking cessation counseling is modest, designing system changes that promote integration of smoking cessation treatment into routine and ongoing care can generate substantial revenue and return on investment.

Note that billing for at least three minutes of smoking cessation counseling applies equally to counseling for patients who are not yet ready to set a quit date, as well as those who are ready to quit.

Current Procedural Terminology (CPT) and Diagnostic Codes

• American Lung Association
• American Association of Family Physicians
• American Psychological Association

Practice management and documentation issues related to seeking reimbursement for inpatient and outpatient tobacco treatment are discussed in this Leone et al., 2016 article in CHEST.

Additional Information

• Medicare tobacco treatment benefits from the University of Wisconsin Center for Tobacco Research and Intervention.
• Medicaid tobacco treatment benefits and copay policies from the University of Wisconsin Center for Tobacco Research and Intervention and the Wisconsin Department of Health Services.
• Coding and billing for inpatient tobacco treatment (p. 26) from the University of Wisconsin Center for Tobacco Research and Intervention.

Other Funding Sources

Reimbursement for billable smoking cessation counseling may not be sufficient to cover all the costs of your tobacco treatment program. Many successful tobacco treatment programs cover some or all of their operating costs with funds from other sources. These often include funds allocated by cancer program or health system leaders and funds raised through philanthropy and fundraising events and portals, as illustrated in this example from the University of North Carolina.

Reducing Patient Out-of-Pocket Costs and Equity Considerations

Costs, including copayments for services or medications covered by insurance, can be a barrier to accessing tobacco treatment for patients. To reduce patient costs and burdens associated with tobacco treatment, some C3I programs shifted from in-person to remote treatment delivery, thereby cutting down on transportation costs (see Case Study A); some provided counseling free of charge rather than billing to insurance (see Case Study E); and some provided free nicotine replacement therapy (see Case Study C).

Finding ways to reduce out-of-pocket expenses for tobacco treatment may be particularly helpful for low socioeconomic status populations. Subsidizing treatment costs may align with health equity goals for your program or center. Such support could be offered to all patients who use tobacco or targeted to underserved and high-need populations. Other forms of support (e.g., transportation vouchers) may also enhance equity by addressing barriers to tobacco treatment for socioeconomically disadvantaged  and rural patients.

See the Health Equity module for more information.