2023 Smoking Cessation Provider Incentive Program

Anthem Blue Cross and Blue Shield Medicaid (Anthem) recognizes the unique challenges providers experience while caring for our members, and we appreciate the quality of care consistently offered by so many of our providers. In recognition of these efforts, Anthem offers the Smoking Cessation Provider Incentive Program (SCPIP). Anthem has designed SCPIP to encourage providers to provide smoking cessation counseling to members who use tobacco, including referring them to Kentucky’s Tobacco Quitline. SCPIP will offer an incentive on paid professional claims, in addition to the reimbursable amount for the service, to providers who:

1. Provide members who use tobacco with intensive smoking/tobacco cessation counseling for greater than 10 minutes.
2. Submit code 4004F in addition to CPT^® code 99407 — Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes, and a primary ICD-10 diagnosis code of F17.200-F17.299.

Performance indicator incentive payment amount and incentive eligibility frequency

The table below shows the incentive payment amount for each eligible occurrence and the incentive eligibility frequency for each performance indicator.

* The 4004F code is billed in addition to 99407.

SCPIP incentive payment

Payments are made to providers with payment of the applicable claim.

Program changes

Anthem reviews program components on an annual basis and updates them as necessary to ensure industrywide, evidence-based information is used to measure and incentivize providers. Anthem reserves the right to modify or amend the program at any time at its discretion.

Anthem may terminate this program at any time. If Anthem terminates this program, Anthem is responsible for payment of eligible SCPIP incentives earned by the provider up to the date of termination of the program.