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Medicare Expansion of Smoking Cessation Counseling

October 25, 2010

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The Centers for Medicare and Medicaid Services (CMS) recently announced an expansion of its smoking cessation counseling benefit to include coverage of asymtomatic patients. Since 2005 Medicare has covered smoking cessation counseling for Medicare beneficiaries who have been diagnosed with a tobacco-related disease or have signs or symptoms consistent with diagnoses related to use of tobacco products. When this benefit first became effective, the AARC did an analysis for members only on the impact on respiratory therapists by care setting.

According to CMS, the Medicare Learning Network® (MLN) has released MLN Matters Article #MM7133 to inform providers that CMS will cover counseling services to prevent tobacco use for outpatient and hospitalized beneficiaries. Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries 1) who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease; 2) who are competent and alert at the time that counseling is provided; and 3) whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. Although respiratory therapists are not considered “Medicare-recognized practitioners” because there is no distinct benefit category that recognizes respiratory therapy services in the Medicare statute, they can furnish smoking cessation counseling “incident to” a physician's professional service.

This article is based on Change Request (CR) 7133 and is available at on the CMS website. It also provides new codes associated with the expanded benefit, their effective dates, and the method of payment to institutional providers based on the type of facility.