CMS Expands Smoking Cessation as a Preventive Measure

September 7, 2010 

On August 25, 2010, CMS announced it will now cover smoking cessation counseling for outpatient and hospitalized Medicare beneficiaries who use tobacco, regardless of whether the patient has signs or symptoms of tobacco-related disease. This action comes as part of the program’s coverage of preventive services that are permitted under the Medicare Improvements for Patients and Providers Act of 2008 if certain statutory provisions are met.

Prior to this expansion of coverage, Medicare only covered smoking cessation counseling for those Medicare beneficiaries who were diagnosed with a recognized tobacco-related disease.

Respiratory therapists should know that this decision does not change current coverage guidelines regarding the types and numbers of smoking counseling sessions permitted in a year. 

• Two individual tobacco cessation counseling attempts are covered per year.
• Each attempt may include up to four sessions, with a total annual benefit covering up to eight sessions per Medicare patient who uses tobacco.
• The practitioner and patient can choose which type of counseling is best for them for each attempt—intermediate (more than 3 minutes) or intensive (more than 10 minutes)
• Minimal counseling (less than 3 minutes) is already covered as part of the Evaluation and Management visit and is not separately billable.

The decision also does not change the circumstances under which a respiratory therapist may provide smoking counseling. Only “Medicare-recognized practitioners” can furnish smoking cessation counseling under this benefit. Respiratory therapists do not qualify under this category because they cannot bill Medicare separately for their services. However, respiratory therapists can furnish smoking cessation counseling “incident to” a physician’s service. In this case, the physician will bill Medicare directly for the service. See AARC’s Analysis by Care Setting for further information.