Tobacco Cessation Counseling

A Centers for Medicare & Medicaid Services decision has just expanded Medicare coverage of Tobacco Cessation Counseling.

Specifically, Medicare will now cover tobacco cessation counseling for Medicare beneficiaries who use tobacco, regardless of whether the patient has signs or symptoms of tobacco-related disease. The counseling may be provided by a physician or other Medicare-recognized practitioner. Medicare's decision to expand this coverage is based on evidence showing that stopping the use of tobacco, at any age, is highly beneficial.

This coverage decision expands not only (1) what is covered (it used to be “smoking cessation,” now it is “tobacco cessation,” which includes smoking, chewing, and so forth); and, (2) which beneficiaries are covered (it used to be that you had to have a disease that is caused or complicated by tobacco use, or took a medicine that is affected by tobacco usage; now any beneficiary who uses tobacco may receive the service).

This benefit will cover two individual tobacco cessation counseling “attempts” per 12-month period. Each attempt may include up to four “sessions,” with a total annual benefit thus covering up to eight sessions. The sessions in each attempt may be either intermediate (more than three minutes) or intensive (more than ten minutes). This is identical to the old benefit.

It will be subject to the Part B deductible and coinsurance this year, but will fall under the Health Care Reform rule that preventive services will be paid 100% by Medicare effective January 1, 2011.