September 2, 2010

MEDICARE COVERAGE FOR SMOKING CESSATION COUNSELING

The Centers for Medicare & Medicaid Services (CMS) announced on August 25, 2010 in a "Decision Memorandum for Counseling to Prevent Tobacco Use" that Medicare will begin covering tobacco cessation counseling for all eligible beneficiaries.  Medicare Part B coverage for smoking cessation counseling had previously been limited to beneficiaries who had been diagnosed with or who showed symptoms of a tobacco-related disease.  Smoking cessation medications may be covered under Part D.

The Affordable Care Act eliminated cost-sharing for most of the preventive services covered by Medicare, effective January 1, 2011.[1]  CMS also announced that, effective immediately, the new tobacco cessation counseling services will be available "at not cost to beneficiaries."[2]

Under the new ruling, the benefit will now be available to all smokers, regardless of whether they have been diagnosed with a tobacco-related illness, or show symptoms of such an illness, as long as they "are competent and alert at the time the counseling is provided."  The counseling must be provided by a Medicare-qualified physician or other practitioner.  Medicare will pay for two counseling attempts consisting of four sessions, for up to eight individual sessions per year for each qualified beneficiary.

Section 101(a) of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA), Publ. Law 110-275, gave CMS authority to expand Medicare coverage of preventive services if the services are reasonable and necessary to prevent or to provide for early detection of an illness or disability; if the services have received a grade of A or B from the United States Preventive Task Force (USPTF); and if the services are appropriate for Medicare beneficiaries.[3]  USPTF has given tobacco cessation counseling a grade of A for adults.  CMS also considered other medical evidence that demonstrates the importance of smoking cessation to improving health and preventing illness, as well as public comments received through the National Coverage Determination process.

The expansion of coverage for tobacco cessation counseling is the first time that CMS has used its authority under MIPPA to add Medicare coverage for a preventive benefit.

Copyright © 2010 Center for Medicare Advocacy, Inc.