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.

Covered Medications

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

Varenicline: Chantix

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).

Co-Pays

None for tobacco cessation. Per the Affordable Care Act, essential health benefits are to be provided without cost to the patient.

Know the Codes

• ICD-10 Diagnostic Codes
• 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. Exclusions: 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: 800-QUIT-NOW (800-784-8669); Available 24/7. 

Medicaid Program Details

Medicaid Enrollment Information