I agree with you Suzanne. As is stands now, MCR only pays for tobacco cessation when it is documented to be "reasonable and necessary for a patient with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information."
Tobacco abuse disorder is not payable by MCR and would become patient responsibility (carved out as you mentioned). To submit a claim with any other diagnosis for payment purposes would result in a false claim (IMHO).
The good news....
Medicare is reviewing their current policy and proposing to pay for tobacco abuse cessation as a preventative measure.
CMS proposes to cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries:
-Who use tobacco, regardless of whether the patient has signs and 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.
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