Smoking Cessation Help in 2011

December 10, 2010

New Medicare coverage for smoking cessation counseling

Question: I heard that there are new guidelines for counseling on smoking cessation coming into effect in 2011. What is new?

Answer: Medicare has indeed updated their reimbursement policy for smoking cessation counseling. Under the Affordable Care Act, CMS is expanding Medicare coverage of evidence-based tobacco cessation counseling, effective Jan. 1. Any smoker covered by Medicare can receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner.

Under the revised policy, Medicare will cover tobacco cessation counseling for outpatient and hospitalized 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; and

•Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

This is a pretty big change because before this decision, Medicare had covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or showed signs or symptoms of such a disease.

Medicare will now 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 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.

All Medicare beneficiaries will continue to have access to smoking-cessation prescription medication through the Medicare Prescription Drug Program (Part D). (Source CMS.gov.)

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or editor@physicianspractice.com.

This question originally appeared in the January 2011 issue of Physicians Practice.