Medicare and tobacco cessation counseling
Fam Pract Manag. 2005 May;14(5):11-12.
Kent Moore's article “What's New in Medicare Preventive Benefits” [February 2007] is a nice review of the preventive services coverage that the Centers for Medicare & Medicaid Services (CMS) provides. As the director of the Ohio Health Nicotine Dependence Program, I noticed a new, important benefit was omitted from the article: tobacco cessation.
In March 2005, CMS determined that coverage should begin for tobacco-use cessation for Medicare beneficiaries. Medicare covers two quit attempts per year, with a maximum of four intermediate or intensive counseling sessions per year (eight sessions per 12-month period). Patients with a tobacco-related condition or symptom are covered as well as patients who are advised to quit because tobacco use is affecting their metabolism or dosing of a therapeutic agent. Documentation of the tobacco-related condition is required.
Hospital-based counseling is also covered by Medicare Part D, but tobacco dependence cannot be the reason for the admission. Physicians and other clinicians recognized by Medicare may bill for tobacco-use cessation services using HCPCS codes G0375 (3 minutes to 10 minutes of counseling time) and G0376 (greater than 10 minutes).
Medicare does not categorize tobacco-use cessation services as a preventive benefit, which is why they were not covered in Kent Moore's article. These services are described in detail in the May 2006 FPM article “An Update on Tobacco Cessation Reimbursement.”
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