Many Alliance members are affected by tobacco use and addiction. Providers have an important role in helping patients quit tobacco use. We developed this guide to describe tobacco prevention and cessation services and share helpful resources.

The Alliance provides coverage of tobacco cessation services, which include assessment, medications, and counseling. In addition, member health education and provider training are available to support tobacco cessation efforts.

The interventions below follow the recommendations from the United States Preventive Services Task Force (USPSTF) for tobacco cessation. Learn more about each of these interventions and other provider resources:

Toolkit last reviewed October 2020

Tobacco Assessment

  • Adolescent / Adult Members: Complete the Staying Healthy Assessment (SHA) for new Alliance members within 120 days of enrollment and annually thereafter.
  • Ask members who use tobacco about their current tobacco use at every visit.
  • ​Use the following ICD-10 codes to record tobacco use in the medical record:
    • 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

Tobacco Cessation Counseling

  • The Alliance covers four or more counseling sessions with the provider for at least two separate quit attempts per year without prior authorization.
  • 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.
    • Read more about how to use these models from the Treating Tobacco Use and Dependence Quick Reference Guide for Clinicians.
    • Watch videos on motivational interviewing from UW Center for Tobacco Research and Intervention.
  • You can also follow the “Ask, Advise, and Refer” model. Refer members of any age to available individual, group, and telephone tobacco cessation counseling. Also refer members to tobacco treatment medicines.
    • Refer members to the California Smokers’ Helpline at 800.NO.BUTTS (1.800.662.8887) or another quit line. Services are available in English, Spanish, Chinese, Korean, and Vietnamese. Providers can make a referral online at nobutts.org.
    • For more programs and information on quitting smoking, please visit Alliance Live Healthy. Providers can request information be mailed to the member with the Provider Wellness Program & Materials Request Form.

Pregnant Women

  • Ask all pregnant women if they use tobacco or are exposed to tobacco smoke.
  • For pregnant women who use tobacco, offer at least one face-to-face counseling session per quit attempt. Counseling services will be covered for 60 days after delivery.
  • Per the USPSTF, current evidence is insufficient to assess pharmacotherapy interventions in pregnant women.

School-aged Children/Adolescents

  • Prevention of tobacco use should be provided according to the American Academy of Pediatrics Bright Futures periodicity schedule and anticipatory guidance.
  • The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-feasible interventions for the cessation of tobacco use among school-aged children and adolescents. Medically necessary tobacco cessation services, including counseling and pharmacotherapy, are covered for children up to age 21 under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

Tobacco Cessation Medications

  • Offer FDA-approved tobacco cessation medications to non-pregnant adults of any age, such as nicotine patch, nicotine gum, nicotine lozenge, nicotine nasal spray, nicotine inhaler, bupropion SR, and Varenicline.
  • Studies have shown that combination therapy, the combination of long acting Nicotine Replacement Therapy (NRT) and short acting NRT, can be very effective. More information can be found at Recommendations for Use of Combination Therapy.
  • Medication may be offered regardless of whether the member participates in tobacco cessation counseling.

Trainings for Providers

  • Providers are strongly encouraged to participate in one or more of the following provider trainings:

Other Resources

Below is additional information on e-cigarettes and vaping as it has become an emerging topic of interest. As of now, the United States Preventive Services Task Force (USPSTF) has found insufficient evidence for or against the use of these products for smoking cessation.

Resources on Vaping

    • Learn about the different shapes and types of e-cigarettes and the risks of all forms of e-cigarette use, including JUUL, for young people.
    • Ask about e-cigarettes, including small, discreet devices such as JUUL, when screening patients for the use of any tobacco products.
    • Educate patients about the risks of all forms of tobacco product use, including e-cigarettes, for young people.
    • Encourage patients to quit. For free help, patients can visit novapes.org or call 1.844.8.NO.VAPE (1.844.866.8273).