Coverage of Conditions and Treatments

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Smoking or other use of tobacco does not meet the definition of an industrial injury or occupational disease and the insurer will not accept it as a condition under the claim. However, tobacco cessation treatment may be covered as a temporary aid to recovery when it is preauthorized prior to surgery and certain criteria are met. This is based on evidence that shows tobacco cessation before surgery helps reduce post-operative complications and improve surgical outcomes.

Required Criteria for Treatment

To provide workers with the best chance of having a good surgical outcome, the insurer will cover tobacco cessation treatment for planned surgeries when all the following criteria are met:

  1. The worker uses tobacco product(s) (cigarettes, pipes, cigars, smokeless tobacco) on a regular basis AND
  2. Tobacco cessation treatment has not previously been paid on the claim, or if it has, an exception for repeat treatment has been made based on individual claim review AND
  3. The provider recommends tobacco cessation treatment, OR L&I’s medical treatment guideline for the surgery recommends or requires tobacco cessation treatment prior to surgery (Table 1) AND
  4. A worker meets the surgical criteria in L&I’s medical treatment guideline when authorization for a planned surgery is requested.

L&I Guidelines Requiring or Recommending Tobacco Cessation

Future guidelines that require or recommend tobacco cessation will be posted on the Medical Treatment Guidelines webpage as they are created.

Treatment Description and Coverage

Studies show the most effective tobacco cessation treatment includes both pharmacotherapy and behavioral therapy or counseling support.

Pharmacotherapy

Pharmacotherapy should start at least 4 weeks before the planned surgery and may continue for up to 12 weeks. It consists of one of the following treatments:

  1. Any combination of covered nicotine replacement therapies (NRT) – patches, gum or lozenges), OR
  2. Varenicline (brand name Chantix) oral medication OR
  3. Bupropion (brand name Zyban) oral medication
Limitations on Pharmacotherapy
  • Nicotine nasal sprays and inhalers are not L&I approved cessation products.
  • Electronic cigarettes (e.g “e-cigarettes” and “vaping”) are increasingly being used to deliver nicotine, sometimes as an aid to quitting cigarettes. There is insufficient evidence for their effectiveness and safety and they are not FDA-approved for tobacco cessation. The department does not cover these products.
  • All medications must be prescribed on standard prescription forms and obtained from a pharmacy for them to be payable.
Behavioral Therapy or Counseling

Behavioral therapy or counseling on quitting tobacco may be done through multiple methods such as in-person office visits, a telephone hotline, or use of an application on an electronic device. L&I covers up to 8 sessions of in-person counseling provided by an L&I covered provider. Workers may have additional resources for behavioral therapy or counseling for tobacco cessation outside the workers’ compensation system, and if so, those services will not be covered by L&I.

Resources for Workers and Providers
Billing Information

Billing information can be found in the Payment Policies section of L&I’s fee schedule.

CPT Codes for Tobacco Cessation Counseling are limited to a maximum of 8 units of any combination.