Updated Medicaid Expansion Coverage for Smoking Cessation

Effective April 1, 2021, Medicaid expanded the list of practitioners who can be reimbursed for providing Smoking Cessation Counseling (SCC) services. The expanded list of practitioners includes Registered Nurses, Clinical Psychologists, Licensed Clinical Social Workers, Licensed Master Social Workers, Licensed Practical Nurses

SCC services, rendered by the previously mentioned list of practitioners, are reimbursable when provided through an Article 28 hospital outpatient department (OPDs), free-standing diagnostic and treatment centers (D&TCs) and federally qualified health centers (FQHCs) including FQHC school-based health centers (SBHCs) that bill using Ambulatory Patient Groups (APGs) and office-based providers. Please note, SCC may take place during individual or group counseling sessions and only one procedure code may be billed per day. NYS Medicaid allows for as many sessions as medically necessary for all Medicaid members. Claims must include a valid International Classification of Diseases (ICD)-10 code for nicotine dependence.

Reimbursable Smoking cessation services are included in the prospective payment system (PPS) rate for those FQHCs that do not participate in APG reimbursement. For additional information please visit the New York State Department of Health website.