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Smoking Cessation
Elimination of Co-payment FAQ
What does the elimination of co-payment for the outpatient smoking cessation counseling mean for veterans in care in VA?
The elimination of the co-payment for outpatient smoking cessation counseling (individual or group) removes any concerns about the co-payment as a potential barrier for any veteran who smokes who wants to quit. There is strong scientific evidence that smoking cessation counseling helps people quit smoking and that providing no-cost counseling increases its use fourfold and that those counseled are four times more likely to quit. Such counseling can range from brief individual sessions with a primary care physician to multiple group counseling sessions in a specialty clinic.
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Why was the co-payment for smoking cessation counseling eliminated?
Veterans receiving care in VA are disproportionately affected by smoking-related illnesses, with a prevalence of smoking 43% higher than the general population. Smoking cessation is one of the most cost-effective prevention interventions, second only to childhood immunizations. Despite its effectiveness, counseling for smoking cessation is widely underutilized in the VA health care systems and other systems nationally. As smoking and tobacco use cessation is a public health priority for the Veterans Health Administration, the co-payment has been eliminated to decrease any potential barriers to counseling and increase access to care for veterans who want to quit using tobacco.
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When will the elimination of the co-payment for smoking cessation counseling go into effect?
Effective May 2, 2005, the co-payment for outpatient smoking cessation counseling (individual or group) was eliminated through the publication of an Interim Final Rule that changed the regulation governing VHA outpatient co-payments. On June 23, the VHA Business Office released a patch to the field implementing this change, and the co-pay became $0 instead of the basic co-payment that was previously charged of Priority Category 7 & 8 veterans. The elimination of the outpatient co-payment will be retroactive to May 2, 2005 and VA will reimburse all Category 7 & 8 veterans who had been assessed and paid a co-payment for smoking cessation counseling on or after May 2.
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Does the elimination of the co-payment for smoking cessation counseling also apply to smoking cessation medications such as nicotine replacement therapy (NRT) and bupropion?
No, there will still be a pharmacy co-payment for any veteran who typically has a medication co-payment. The elimination of the co-pay applies only to smoking cessation counseling only.
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Does the elimination of the co-payment for smoking cessation counseling apply to only primary care settings in VA?
No, the elimination of the co-payment for either individual or group smoking cessation counseling is applicable to
any outpatient setting in VA. However, in order to ensure that a co-payment for outpatient smoking cessation counseling is not assessed, the following stop codes must be used:
533707 Smoking Cessation Counseling –
Individual
566707 Smoking Cessation Counseling -
Group
If other stop codes are used, the patient may be charged a co-payment.
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Additional Information
If you have questions about the elimination of the smoking cessation counseling co-pay or smoking or tobacco use cessation, please contact Dr. Kim Hamlett-Berry of the Public Health National Prevention Program at (202) 273-8929. If you have questions about the implementation of the elimination or the related VistA patch that will include the new outpatient co-payment schedule, please contact Ms. Eileen Downey of VHA Business Office at (202) 501-0639.
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