MedicaidCoverageMedium impact
Wisconsin Medicaid tobacco cessation services
Wisconsin Medicaid (ForwardHealth)·WI · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Feb 1, 2003
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid clarifies tobacco cessation services coverage, specifying that E&M visits must be one-on-one face-to-face (no group or phone sessions), ancillary staff require direct physician supervision and are limited to level-two office visits (CPT 99212), and prescription drugs are covered but not over-the-counter nicotine products.
Action Required
Immediately: Billing team must ensure Wisconsin Medicaid tobacco cessation claims use CPT 99212 when provided by ancillary staff under direct physician supervision, with the supervising physician listed as performing provider on CMS 1500 forms. Stop billing for group sessions or telephone consultations under E&M codes for tobacco cessation services.