Medicare to Cover Smoking Cessation
Regardless of Presence of Smoking-Related Conditions
In September Medicare finally agreed to pay for smoking cessation counseling for smokers who are not yet sick. Since 2005 Medicare has covered such counseling, but only for those who have an illness caused by, or complicated by, tobacco use.
Medicare will now cover tobacco cessation counseling for outpatient and hospitalized Medicare 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.
Medicare will 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 thus covering up to eight sessions per Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than three minutes) or intensive (more than ten minutes) cessation counseling sessions for each attempt.
This change does not modify existing coverage for minimal individual cessation counseling (three minutes or less), which is already covered as part of each Evaluation and Management (E&M) visit and is not separately billable.
The new smoking cessation program might seem a tad late. People usually smoke for decades before they get cancer, emphysema, heart disease and other smoking-related disorders — just in time for Medicare to pick up the tab. But the Center for Medicare and Medicaid Services (CMS) decision memo noted that even older smokers who quit can see fairly quick payback in terms of reduced illness.
Smoking costs the U.S. economy $97 billion annually in lost productivity, in addition to the $96 billion a year in direct health care costs, according to CMS. Counseling coupled with smoking prevention drugs and devices are among the most cost-effective interventions in the disease prevention arsenal.
-From “Decision Memo for Counseling to Prevent Tobacco Use (CAG-00420N)”, CMS, http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=242& retrieved 9/23/10, and “Medicare: A Prevention Plan that Could Lower Costs” by Merrill Goozner, The Fiscal Times, http://www.kaiserhealthnews.org/Stories/2010/September/01/FT-medicare-smoking-prevention.aspx retrieved 9/10/10; cited in/linked from ElderLaw News from ElderLawAnswers, September 10, 2010.
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