Promoting Tobacco Recovery in 2025: Strategies for Successful Treatment and Reimbursement

Highmark Wholecare recognizes the impact tobacco has on the well-being of our members, particularly those from marginalized communities who may face additional barriers to recovery. We are committed to supporting members on their individual journeys toward tobacco recovery, acknowledging that this is a process with varying stages and needs. For members with respiratory conditions, diabetes, cardiovascular diseases, and other chronic conditions, reducing or eliminating nicotine use can improve health outcomes—lessening the frequency and severity of symptoms, slowing disease progression, improving medication effectiveness, and reducing the risk of infections and cancers.

You play a vital role in supporting your patients’ tobacco recovery. We encourage your efforts through reimbursement for tobacco recovery counseling (that is, tobacco cessation counseling) provided to our Medicaid and Medicare D-SNP members.

To be eligible for reimbursement, providers must register as a pre-approved tobacco cessation counselor through the DHS website by completing a simple application and a brief online training. Once registered, our providers can bill for tobacco cessation services using procedure code 99407. Highmark Wholecare covers 70 “> 10-minute counseling sessions” per year per member. Please follow CPT guidelines regarding billing for separate and distinct services when using modifier 25.

Tobacco use screenings and brief interventions are key components of both prevention and recovery strategies. Providers should begin screening at age 11 and continue at least annually. A positive screen should be followed by a confirmatory assessment and brief intervention. Although brief physician counseling can improve outcomes, longer counseling sessions (over 10 minutes) are significantly more effective, approximately doubling abstinence rates compared to shorter interventions. ¹ Our Tobacco Recovery Guide outlines screening tools, intervention methods, suggested talking points, and other resources to aid you in this process.

Additionally, medication therapy can significantly improve the chances of successful tobacco recovery. Pharmacological aids such as nicotine replacement therapy (NRT) and prescription medications can help manage withdrawal symptoms and increase success rates. Our Tobacco Recovery Guide details Highmark Wholecare coverage for these products and lists various community resources, such as the Pennsylvania Free Quitline (1-800-QUIT-NOW).

Thank you for your support in reducing tobacco use among our members and promoting better overall health outcomes.

¹ https://pmc.ncbi.nlm.nih.gov/articles/PMC2935501/