The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that counseling to prevent tobacco use, which is recommended with a grade of A by the U.S. Preventive Services Task Force (USPSTF) for all adults and pregnant women who use tobacco, is reasonable and necessary for prevention of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare 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.
• Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

CMS 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 3 minutes) or intensive (more than 10 minutes) cessation counseling sessions for each attempt. 

This decision memorandum does not modify existing coverage for minimal individual cessation counseling (3 minutes or less), which is already covered as part of each Evaluation and Management (E&M) visit and is not separately billable. 

1. Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Database. Decision Memo for Counseling to Prevent Tobacco Use (CAG-00420N). August 25, 2010. Available at: http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=242&. Accessed August 26, 2010.

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This entry was posted on Thursday, August 26th, 2010 at 12:00 pm.