Counseling to Prevent Tobacco Use

CMS National Coverage Determination | ncd_id=342 | manual_section=210.4.1 | coverage_level_code=1 | national_coverage_type=True | under_review=True | lab_ncd=False

B. Nationally Covered Indications Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries Who use tobacco, regardless of whether they have 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. Intermediate and intensive smoking cessation counseling services will be covered under Medicare Part B when the above conditions of coverage are met, subject to frequency and other limitations. That is, similar to existing tobacco cessation counseling for symptomatic individuals, CMS will allow 2 individual tobacco cessation counseling attempts per 12-month period. Each attempt may include a maximum of 4 intermediate OR intensive sessions, with a total benefit covering up to 8 sessions per 12-month period per Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than 3 minutes but less than 10 minutes), or intensive (more than 10 minutes) cessation counseling sessions for each attempt. C. Nationally Non-Covered Indications Inpatient hospital stays with the principal diagnosis of tobacco use disorder are not reasonable and necessary for the effective delivery of tobacco cessation counseling services. Therefore, we will not cover tobacco cessation services if tobacco cessation is the primary reason for the patient’s hospital stay. D. Other Section 4104 of the Affordable Care Act provided for a waiver of the Medicare coinsurance and Part B deductible requirements for this service effective on or after January 1, 2011. Until that time, this service will continue to be subject to the standard Medicare coinsurance and Part B deductible requirements. (This NCD last reviewed December 2016.)