MedicaidCoverageMedium impact
Newsletter Vol. 22, No.02
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, OB-GYN +4 more·Medical Policy
Effective date
Jan 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJFC) now covers tobacco cessation services with specific billing requirements: minimum 4 face-to-face counseling sessions per quit attempt (up to 2 attempts/year), coverage for pregnant women through 60 days postpartum, and zero cost to beneficiaries. Billing teams must use HCPCS codes 99406 or 99407 for reimbursement; prior authorization is required for combination therapies and extended treatment beyond 24 weeks.
Action Required
Immediately: (1) Billing team must update billing system to recognize HCPCS codes 99406 and 99407 for tobacco cessation counseling claims submitted to NJFC/Medicaid. (2) Update provider encounter forms and documentation templates to capture tobacco cessation sessions and ensure minimum 4 face-to-face sessions per quit attempt are documented. (3) Implement system logic to enforce zero cost-sharing for these services for NJFC/Medicaid beneficiaries. (4) Establish prior authorization workflow in billing software for combination-treatment modalities and treatment durations exceeding 24 weeks before submission. (5) Providers and clinical staff must ensure eligible providers (physicians, APNs, clinical nurse specialists, nurse midwives, FQHCs, independent clinics) are credentialed to bill these codes. Failure to comply will result in claim denials for improper code usage or missing prior authorizations.