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Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019

Last updated on 3/19/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after May 1, 2019, smoking and tobacco use cessation counseling benefits will change for Texas Medicaid.

Overview of Benefit Changes

Changes to this benefit include the following:

  • Expansion to include additional clients
  • Additional payable diagnosis codes

Smoking and tobacco use cessation counseling benefits will no longer be restricted to women with a diagnosis of pregnancy related complications due to tobacco use.

Effective for dates of service on or after May 1, 2019, procedure codes 99406 and 99407 will become benefits for male and female clients ages 10 and older.

Additional Diagnosis Restrictions

In addition to the currently payable diagnosis codes for pregnancy complications, procedure codes 99406 and 99407 will be updated to include the following payable diagnosis codes:

New Payable Diagnosis Codes

F17200

F17201

F17203

F17208

F17209

F17210

F17211

F17213

F17218

F17219

F17220

F17221

F17223

F17228

F17229

F17290

F17291

F17293

F17298

F17299

Current Diagnosis Codes for Pregnancy Complications

O99330

O99331

O99332

O99333

O99334

O99335

Existing Limitations

Procedure codes 99406 and 99407 may be billed in any combination by the same or different provider and are limited to eight services per rolling year. Additional services require documentation of medical necessity to exceed the established limit.

Procedure codes 99406 and 99407 are limited to once per day, same or different procedure code, any provider.

For more information, call the TMHP Contact Center at 800-925-9126.