Figure 1: myths about the wisconsin medicaid program’s coverage for tobacco dependence treatment

Quit Tobacco Series
Medicaid, BadgerCare and SeniorCare 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 recipients is much higher than among the general
• Coaching on how to quit—combined with medication—can quadruple the chances of successfully
Covered Medications
Medicaid, BadgerCare & SeniorCare cover the following FDA-approved medications:

 Bupropion SR: Zyban, Wellbutrin or generic  Nicotine inhaler: Nicotrol  Nicotine nasal spray: Nicotrol  Nicotine patch: Over-the-counter, or prescribed as “legend” (SeniorCare covers only prescription  Nicotine gum: Over-the-counter (SeniorCare does not cover nicotine gum)  Varenicline: Chantix  Combination therapy
Please Note:
 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)
 $3 for each brand name drug  $1 for each generic drug  $.50 for each over the counter drug  Co-pay maximum = $12/member/month/pharmacy for legend drugs  No monthly co-pay maximum for over-the-counter drugs
Know the Codes:
 Diagnostic code 305.1 is REQUIRED on all prescriptions
 Billing Codes = 99201-99205 for new patients; 99211-99215 for established patients.

Covered Counseling
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.

Group therapy, telephone and web-based counseling are NOT covered. Counseling is NOT
reimbursed for dentists or dental hygienists.

Quit Line:
The Wisconsin Tobacco Quit Line is free and available to assist all Wisconsin residents who
want to quit: 1-800-QUIT-NOW (800-784-8669); 7 a.m. to 11 p.m. daily.
Produced by the University of Wisconsin Center for Tobacco Research & Intervention July 2010 Quit Tobacco Series
Produced by the University of Wisconsin Center for Tobacco Research & Intervention July 2010


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