CMS Expands Tobacco Cessation Counseling Coverage

Under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) is expanding Medicare coverage of evidence-based tobacco cessation counseling. Effective Jan. 1, 2011, any smoker covered by Medicare can receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner.

Current Medicare policy covers tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or for those who show signs or symptoms of such a disease.

“Today’s decision builds on the existing preventive services that are available to Medicare beneficiaries,” said CMS Administrator Don Berwick, M.D. “Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life. As a result, all Medicare beneficiaries now have more help to avoid the painful—and often deadly—consequences of tobacco use.”

Under the revised policy, Medicare will cover tobacco cessation counseling for outpatient and hospitalized beneficiaries:

  • Who use tobacco, regardless of whether the patient has signs or symptoms of tobacco-related disease;
  • Who are competent and alert at the time that counseling is provided; and
  • Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

Medicare will cover two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit thus covering up to eight sessions per Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than three minutes) or intensive (more than 10 minutes) cessation counseling sessions for each attempt.

The Aug. 25 Counseling to Prevent Tobacco Use Decision Memo does not modify existing coverage for minimal individual cessation counseling (three minutes or less), which is already covered as part of each evaluation and management (E/M) visit and is not separately billable.

Today’s final coverage decision applies to services under Medicare Parts A and B and does not change existing Medicare Prescription Drug Program (Part D) policy, or any state-level policies for Medicaid or the Children’s Health Insurance Program (CHIP).

CMS will issue guidance in the coming months about a new benefit for pregnant women to receive Medicaid-covered tobacco cessation counseling. This new benefit, also a provision of the Affordable Care Act, requires states to make coverage available to pregnant Medicaid beneficiaries by Oct. 1.

To read more about today’s final coverage decision, visit the CMS website. To learn more about the preventive services available to Medicare beneficiaries, visit the “Manage Your Health” page on the website.

 Source: CMS press release


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One Response to “CMS Expands Tobacco Cessation Counseling Coverage”

  1. Ernie Medina, Jr. says:

    Great move, but had a question on just who a “Medicare-recognized practitioner”? Here we have graduate-level health educators who do our smoking cessation program, but I don’t think they are approved for Medicare, so would this exclude them from being covered?

    It’s actually a moot point for our medical group because our smoking cessation counseling (both group, individual, and online) is free to anyone, regardless of coverage (even no coverage at all!). Just curious who this type of practitioner was.

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