Provider Alert! Vaping and Smoking Cessation Benefits Reminder

Date: July 13, 2021

Attention: Primary Care Physicians and Pulmonologists

Call to action: Providers are reminded that screening and information on smoking cessation should be included as part of any routine patient visit. Diagnosis code, U070 should be utilized for reporting vaping-related disorders as a benefit of Texas Medicaid. Procedure codes, 99406 and 99407 should be utilized for reporting a smoking and tobacco cessation counseling visit.

How this impacts providers: Providers should educate susceptible patients presenting with respiratory symptoms or other related health conditions on the severe health risks associated with vaping and tobacco use in general if they are a user. As part of the education, providers should direct patients to utilize the resources that are available to their patients.

Tobacco Cessation Benefits in Medicaid

Medicaid provides tobacco cessation counseling (procedure code 99406 & 99407) individually and in group settings to members 10 years and older with a diagnosis of nicotine dependence.

Adolescents with a diagnosis of nicotine dependency related to aerosolized nicotine delivered by vape device are eligible for tobacco cessation counseling as well.

The Medicaid formulary in the link below includes select medications and nicotine replacement products to support tobacco cessation. https://txstarchip.navitus.com/pages/formulary.aspx
Tobacco Cessation Benefits in CHIP

A TCHP provider or health plan-approved tobacco cessation benefit is covered of up to $100 limit per 12-month coverage period. The health plan may require prior authorization and use of a formulary. See link below for requirements.
https://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf

CHIP Perinatal Program:

• Tobacco cessation programs are not a covered benefit for the unborn child.
• Coverage for the CHIP Perinatal newborn is the same as coverage for traditional CHIP clients.

The CHIP formulary includes select medications to support tobacco cessation.

Next steps for providers: Recommendations for Providers include the following.

• Ask patients presenting with respiratory symptoms about vaping history. If possible, inquire about the types of products used and methods of use.
• If vaping fluid commonly used by the patient is available, ask that an unused sample is available in case it is needed for testing.
• Be aware that some suspect cases have required high-level intensive care and respiratory support.
• Providers are reminded to use appropriate coding as defined by Medicaid; this includes using diagnosis code U070 for reporting vaping-related disorders as a benefit of Texas Medicaid. Procedure codes, 99406 and 99407 should be utilized for reporting a smoking and tobacco cessation counseling visit.

Additional resources:

State resources:
https://www.dshs.texas.gov/vaping/
https://www.dshs.texas.gov/tobacco/

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.