Provider Education

The simple answer to how to quit tobacco is that there is no simple answer. Different methods work for different people, and no two paths to quitting are the same. Often, several attempts are needed before the right method is found. However, as a healthcare provider, the best thing you can do for your patients is to recommend they quit, point them in the direction of proven cessation methods, and provide the encouragement and inspiration needed to help them stick with it.


Though primary care providers are in an excellent position to provide tobacco cessation interventions with their patients who use tobacco products, it can be difficult and sometimes uncomfortable to approach the topic. We recommend treating tobacco use as a vital sign so that a patient’s tobacco use status is readily apparent upon their entrance into the exam room. This is an easy way to integrate conversations about tobacco use into the clinic visit. Tobacco use can be a chronic, relapsing condition that at times requires varying levels of intervention. We encourage you to go as far as you can with each patient at each visit as you help lay the groundwork for tobacco cessation.

In order to assess your patient’s level of nicotine dependence, we suggest using the test in Fagerström Test for Nicotine Dependence. The level of your patient’s nicotine dependence has important indications for the regimen that should be suggested for treatment.

It can be difficult to know what to say to your patient, here are some simple scripts for your use.


English: 1.800.QUIT.NOW (1.800.784.8669)
Spanish: 1.855.DÉJELO.YA (1.855.335.3569)
TTY: 1.877.777.6534
Hours of operation: 24 hours a day, 7 days a week

Believe it or not, telephone counseling is one of the most effective ways to help people quit smoking or chewing tobacco. In contrast to in-person counseling, it eliminates the need for transportation and childcare, as a person can access services from wherever there’s a telephone. Help can be obtained on the person’s own timetable and terms, and critical assistance is just a phone call away.

When someone calls the Utah Tobacco Quit Line, they can:

  • Be connected with a trained coach who will help them develop a personalized quit plan, and guide them through the quitting process.
  • Receive up to five individually tailored sessions with a coach.
  • Get a self-help booklet and information about online resources.
  • Opt in for text messaging reminders and support.
  • Receive information about how to help a friend or family member to quit.
  • Be able to discuss options for medications, including free Nicotine Replacement Therapy (NRT) to eligible callers (youth are not eligible for NRT).

Quit line services are completely confidential and available in English and Spanish. Translation is also available into more than a hundred other languages. All services are free to Utah residents.

Check here to determine if free promotional materials are available at your local health department.


Online Coaching is a free, internet-based service designed to help individual tobacco users through the quitting process. Its interactive tools and features can be used 24 hours a day, seven days a week, for as long as needed. At any time, tobacco users can log on for information and support. Utah online coaching members can take advantage of:

  • Tools to help them through the quitting process
  • Smoking cessation tips and answers to frequently asked questions
  • Access to medication guides
  • Interaction with quitting experts

All these services are free to Utah users. Online coaching can be used alone or in combination with other services, like the Utah Tobacco Quit Line, for added support.


The Utah Tobacco Cessation Resource Directory is provided as a public service by the Utah Department of Health Tobacco Prevention and Control Program. The purpose of the directory is to assist tobacco users and health professionals in locating tobacco cessation resources in their local area. We encourage you to contact these agencies or programs if you are interested in more specific information about the length, content and cost (if any) of programs.

County Resources

Statewide Resources

Teen Resources

Ethnic Resources


In Utah, the Medicaid system is part of the Department of Health. Medicaid clients tend to have higher smoking rates than average, so the Tobacco Prevention and Control Program (TPCP) partners with Medicaid to offer quitting services to its clients. The program offers services through the Utah Tobacco Quit Line and includes coverage of tobacco cessation medications, as well as additional help for pregnant women. To learn more, contact TPCP at 1-877-220-3466.


Through a grant from the TPCP, participating Association for Utah Community Health (AUCH) community health centers offer Zyban and Chantix free of charge for their uninsured clients. To be eligible for these services, the client must be uninsured, a tobacco user, and an established client with a primary care provider at a participating community health center. If you are uninsured but do not currently go to a community health center for your primary care, you must become a client of the community health center for all of your primary care needs before you will be eligible to participate in this program. Contact your nearest community health center for more information.

African Americans & Smoking Cessation

Native Americans & Tobacco Use

Tobacco Use & Hispanics

LGBT Population & Smoking


As of January 2014, the Affordable Care Act (ACA) requires insurance plans to cover many clinical preventive services. Some of the covered preventive services include:

  1. Tobacco use screening for all adults
  2. Tobacco cessation counseling for adults who use tobacco, and expanded counseling for pregnant women


Medicare Part B covers both intermediate and intensive levels of tobacco cessation counseling for symptomatic and asymptomatic patients.

Two cessation attempts are covered per year, and both coinsurance and deductibles are waived. Each attempt may include a maximum of four intermediate or intensive counseling sessions. The total annual benefit covers up to eight smoking cessation counseling sessions in a 12-month period. The patient may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare-covered cessation counseling session.

To qualify for payment from Medicare, the following criteria must be met at the time of service:

  • Patients must be competent and alert.
  • Counseling must be provided by a physician or other Medicare-recognized practitioner.


Symptomatic patients are those who use tobacco and:

  • Have been diagnosed with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use.
  • Take a therapeutic agent for which the metabolism or dosing is affected by tobacco use, based on information approved by the U.S. Food and Drug Administration (FDA).

Use the following CPT codes for symptomatic patients.

CODE Type of Counseling Description
99406 Intermediate Smoking and tobacco-use cessation counseling visit greater than three minutes but not more than 10 minutes.
99407 Intensive Smoking and tobacco-use cessation counseling visit greater than 10 minutes.

Asymptomatic Patients

Asymptomatic patients are those who use tobacco but do not have symptoms of a tobacco-related disease. Use the following CPT codes for asymptomatic patients.

CODE Type of Counseling Description
G0436 Intermediate Smoking and tobacco use cessation counseling visit greater than 3 minutes but not more than 10 minutes.
G0437 Intensive Smoking and tobacco use cessation counseling visit greater than 10 minutes.

Use the following ICD-10 CM codes with the above CPT codes. The ICD-10 CM codes may be used for either symptomatic or asymptomatic patients, with the exception of Z87.891, which is for use with asymptomatic patients only.

CODE Type of Counseling Description
99406 Intermediate Smoking and tobacco-use cessation counseling visit greater than three minutes but not more than 10 minutes.
99407 Intensive Smoking and tobacco-use cessation counseling visit greater than 10 minutes.

Use the following CPT codes for patients who use tobacco but do not have symptoms of tobacco-related disease:

CODE Description
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
    *For use with asymptomatic patients only

*For each patient receiving smoking and tobacco-use cessation counseling or counseling to prevent tobacco use, medical record documentation must show and include standard information along with sufficient patient history to adequately demonstrate that Medicare coverage conditions were met.


Medicare Part D covers FDA-approved cessation drug therapies. However, over-the-counter therapies are typically excluded.



Many states offer some payment for individual tobacco cessation and treatment counseling for Medicaid patients. However, providers are encouraged to contact their state Medicaid office for coverage information in their specific state.


As of January 1, 2014, all state Medicaid programs are required to support all FDA-approved smoking cessation medications without requiring co-pays or other financial barriers.


Private insurers are required to provide evidence-based tobacco cessation counseling and interventions to all adults and pregnant women. Private payer benefits are subject to specific plan policies. Providers need to check with insurance plans to determine what specific interventions are included and the extent to which they are covered.

CODE Type of Counseling Description
99406 Intermediate Smoking and tobacco-use cessation counseling visit greater than three minutes but not more than 10 minutes (Short Descriptor: Smoke/tobacco counseling 3-10).
99407 Intensive Smoking and tobacco-use cessation counseling visit greater than 10 minutes (Short Descriptor: Smoke/tobacco counseling greater than 10).
S9075 Smoking Cessation Treatment
S9453 Smoking Cessation Classes Non-physician provider, per session
99381-99397 Preventive Medicine Services Comprehensive, preventive evaluation based on age and gender to include appropriate history, examination, counseling/anticipatory guidance, risk factor reduction interventions, and related plan of care
99078 Physician Educational Services Group Setting (e.g., Prenatal, Obesity, Diabetes)

Various E/M services (associated with acute or chronic care) may be coded. When providing an E/M service, if greater than 50 percent of face-to-face time with patient is spent on counseling, time may be used as a basis for selection of level of service.

305.1 Tobacco-use disorder
649.0x Tobacco-use disorder complicating pregnancy, childbirth or puerperium
989.84 Other substances, chiefly nonmedicinal as to source, tobacco*
  • List additional code to specify nature of toxic effect. Excludes localized toxic effects classified elsewhere and respiratory conditions due to external agents and, if applicable, any diagnosis code(s) for condition(s) evaluated and managed in the same encounter.*
  • All codes with .x or .xx require fourth or fifth digits. See the ICD-9 manual for complete descriptions.

*This list was formulated based on the 2004 Surgeon General’s Report on the Health Consequences of Smoking. It is not an all-inclusive list and may be subject to different interpretation of the report.

For a more comprehensive list of billing codes and information on how to use them, please see the American Lung Association’s Billing Guide for Tobacco Screening and Cessation here.


Resources for patients who do not have insurance coverage or who have limited coverage from their insurance carrier include the following:

  • Quit lines (1-800-QUIT-NOW)
  • Online cessation resources (Online Coaching)
  • Flexible spending accounts if smoking cessation is an allowable expense
  • Employee Assistance Programs (EAP); tobacco cessation may be covered by EAPs in some cases.
  • Community resources and support groups
  • Out-of-pocket spending

Visit the following recources for the most effective training and Continuing Medical Education (CME) courses to build your knowledge on tobacco use cessation and secondhand smoke exposure.


PediaLink Course: Addressing Tobacco Use and Exposure
(click the ‘online courses’ option, and you will see it listed)
Available June 12, 2013 – June 12, 2016
AAP Credit = 1.00
AMA PRA Category 1 Credit(s)™ = 1.00
NAPNAP Credit = 1.00
Pharmacology Rx = 0.50


The AAP Richmond Center hosts an ongoing webinar series to educate clinicians on child health issues related to tobacco control. Click here to view past webinars. Note that all of these webinars are presented free of charge.

Tobacco Training and CME Courses From Other Organizations:

  • Become a Tobacco Treatment Specialist
    • The Association for the Treatment of Tobacco Use and Dependence provides a listing of the different trainings that can assist in becoming a certified tobacco treatment specialist.
  • Clean Air for Healthy Children and Families
    • Training and materials to implement tobacco cessation in your practice. These materials are offered through the Pennsylvania Chapter of the American Academy of Pediatrics.
  • Clinical Management of the Patient who Uses Tobacco
    • This interactive curriculum is intended for use in a classroom by an instructor, but can also be used by small groups of students, or by an individual. Covered in the curriculum are the 5As (full and modified), as well as Motivational Interviewing, pharmacology, and the nature of addiction.
  • Global Tobacco Control: Online Courses
    • This site is an online resource that provides free online trainings, research-based reports and guides, and information on the capacity building programs of the Institute for Global Tobacco Control (IGTC) within the Johns Hopkins Bloomberg School of Public Health.
  • Smoking Cessation: Effective Intervention Strategies
    • This course is a collaborative effort of the Morehouse School of Medicine and the Mercer School of Medicine. It is intended primarily for medical students, who can register to receive academic curriculum credit.
  • Tobacco Treatment Training
    • This site uses Web-based programs that provide training in tobacco treatment that prepares physicians to provide clinical tobacco interventions for prevention and cessation.
  • Tobacco Use and Dependence: An Updated Review of Treatments
    • A free CME/CE credit course for physicians, nurses, and respiratory therapists developed by the University of Wisconsin Center for Tobacco Research and Intervention and focused on the Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update.
  • Treatment of Tobacco Dependence
    • This module, from the American Medical Association, is aimed to help learners describe approaches to determining the level of tobacco dependence and assessment of the patient’s readiness to attempt smoking cessation.
  • University of Wisconsin Center for Tobacco Research and Intervention (CTRI)
    • The CTRI combines tobacco control research with practical application in these videos and webinars. Providers of several disciplines are addressed, with videos for pharmacists, dental teams, and pulmonary providers.


  1. Smoking and Diabetes CDC Fact Sheet
  2. Motivational Interviewing Resources