The United States Preventive Services Task Force (USPSTF) recommends that health care providers ask all individuals ages 18 years and older about tobacco use and that providers offer tobacco cessation interventions to those who use tobacco products. Providers should also offer tailored counseling to pregnant women who smoke. Finally, interventions, education or brief counseling should be offered to prevent initiation of tobacco use in school-aged children and adolescents.
L.A. Care makes resources and trainings available to providers to ensure compliance with All Plan Letter (APL) 16-014 Comprehensive Tobacco Prevention and Cessation Services for Medi-Cal Beneficiaries.
What are the tobacco cessation interventions I need to implement?
Conduct an initial and annual assessment of tobacco use for each adolescent and adult beneficiary.
Use the following ICD-10 codes to record tobacco use in the medical record or view the full set of ICD-10 codes.
- F17.200 Nicotine dependence, unspecified, uncomplicated
- F17.201 Nicotine dependence, unspecified, in remission
- F17.210 Nicotine dependence, cigarettes, uncomplicated
- F17.211 Nicotine dependence, cigarettes, in remission
- F17.220 Nicotine dependence, chewing tobacco, uncomplicated
- F17.221 Nicotine dependence, chewing tobacco, in remission
- F17.290 Nicotine dependence, other tobacco product, uncomplicated
- F17.291 Nicotine dependence, other tobacco product, in remission
- Z87.891 Personal history of nicotine dependence
- Place an identifying stamp or sticker on the charts of patients who use tobacco.
Offer FDA approved tobacco cessation medications to non-pregnant adults of any age.
The medications include: Bupropion SR (without prior authorization), Varenicline, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, and nicotine patch.
A 90-day treatment regimen of medications may be prescribed without other restrictions.
Refer tobacco users of any age to available individual, group, and telephone tobacco cessation counseling.
Use the "5A's" (Ask, Advise, Assess, Assist, and Arrange) or the "5 R's" (Relevance, Risks, Rewards, Roadblocks, Repetition) to provide individual counseling to patients during office visits. A minimum of four counseling sessions of at least ten minutes must be offered. You may also:
Ask all pregnant women if they use tobacco or are exposed to tobacco smoke.
If a smoker, offer at least one face-to-face counseling session per quit attempt and refer to a tobacco cessation quit line. Counseling services will be covered for 60 days after delivery. Smoking cessation medications are not recommended during pregnancy.
Provide education or counseling to prevent initiation of tobacco use in school-aged children and adolescents.
Refer L.A. Care patients to individual, group or telephonic tobacco cessation services.
Provide anticipatory guidance and risk-reduction counseling regarding tobacco use to children and adolescents. Order tobacco prevention and cessation health education materials using L.A. Care's online health education materials order form.
Providers are strongly encouraged to participate in one or more of the following provider trainings:
- The UC Quits Series offers no-cost CME units through the University of California, Davis Health System. There are eight modules total.
- CA Smoker's Helpline free training and resources.
- CDC Coverage for Tobacco Use Cessation Treatments
- Overview of the "Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update" (State Medicaid Directors Letter # 11-007)
- Smokefree.gov evidence-based smoking cessation tools and content
- USPSTF - Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions
- USPSTF - Tobacco Use in Children and Adolescents: Primary Care Interventions
Review the following provider training information:
- USPHS "Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008".
- Special requirements for providing services for pregnant tobacco users - - "Smoking Cessation During Pregnancy: Committee Opinion".
- Counseling using the "5A's" model" or other validated model for treating tobacco use and dependence.
Offer medication for at least two separate quit attempts per year with no mandatory break required.
Medication may be offered regardless of whether the member participates in tobacco cessation counseling. Prescribe tobacco cessation medications using L.A. Care's formulary guide. At least one FDA-approved tobacco cessation medication is available without prior authorization.
For additional resources, your patients should call L.A. Care Member Services and ask for the Health Education Department.