HHS Expands Medicare Coverage of Tobacco Cessation Counseling

Diagnosis Requirement No Longer Barrier to Payment

September 01, 2010 04:05 pm David Mitchell

Beginning next year, Medicare will pay for tobacco cessation counseling for all tobacco users covered by the federal benefit program.

[Stock photo of No Smoking sign]

Under the recently enacted Patient Protection and Affordable Care Act, certain preventive care services(www.medicare.gov), such as tobacco cessation counseling, will be covered by Medicare at no cost to beneficiaries. The new benefits, which also include annual physical exams and certain screenings, take effect Jan. 1.

Medicare previously had covered tobacco counseling only for patients diagnosed with a tobacco-related disease or symptoms of such a disease.

"It's great news," said Thomas Weida, M.D., a professor in the department of family and community medicine at the Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, and medical director of the Penn State Hershey Medical Group, Fishburn Road. "Now we don't have to find a diagnosis that's covered in order to get paid for tobacco cessation counseling.

"It's a breath of fresh air for our Medicare patients."

HHS, which announced the change in an Aug. 25 news release(www.cms.gov), estimates that about 46 million Americans smoke, including an estimated 4.5 million Medicare beneficiaries who are 65 or older.

The new benefit also will cover patients younger than 65 who are covered by Medicare because of a disability.

Medicaid to Cover Tobacco Cessation Services for Pregnant Women

In addition to Medicare benefit changes called for under the recently enacted Patient Protection and Affordable Care Act, the new health care reform legislation also requires states to make coverage of "comprehensive tobacco cessation services," including tobacco cessation counseling, available for pregnant Medicaid beneficiaries by Oct. 1 of this year. HHS said it will issue guidance on that new benefit "in the coming months."

Weida, a member of the AAFP's Tobacco Cessation Advisory Committee, told AAFP News Now that the expansion of benefits should encourage more physicians to offer tobacco counseling to Medicare patients.

"If they're a Medicare patient, it's covered, period," he said. "It keeps things simple. Billing is complex enough as it is."

HHS said in its news release that the new benefit will cover two individual tobacco cessation counseling attempts per year, and each attempt may include as many as four sessions, for a maximum of eight sessions per year.

Weida, a family physician and geriatrician, said at least 40 percent of his patients are seniors. The expanded benefit, he said, gives physicians more options for treatment.

"We were sort of stuck before," he said. "We couldn't give patients the full range of services or counseling. Instead of just referring them to a quitline, now we can talk more about other interventions and pharmacological agents that might be helpful. And we can tailor those interventions to the individual. It's not 'one-size-fits-all.'"