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Tobacco use is the leading preventable cause of premature death in the United States and accounts for 30% of all cancer deaths. The 2004 Surgeon General's report on the Health Consequences of Tobacco noted that tobacco use is linked to at least 10 cancers. Oncologists and other cancer care professionals all too often see the devastating consequences of smoking, but can play a critical role in counseling their patients to help them quit. ASCO recently published a Practical Tips article in the October 2004 ASCO News highlighting the new Medicare coverage policy for tobacco use cessation counseling and that guidance is reiterated here. In addition, to further assist oncologists and cancer care providers to help their patients quit smoking, this article provides additional evidence-based resources and tools that may be utilized in the physician's office.
The Centers for Medicare & Medicaid Services (CMS) recognizes smoking and tobacco use cessation counseling services provided by physicians as separately payable. The decision to cover these services is based on current U.S. Public Health Service recommendations and the 2000 clinical practice guideline, Treating Tobacco Use and Dependence (www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf).
CMS considers minimal counseling services—defined as cessation counseling lasting 3 minutes or less—to be included in established evaluation and management codes. Two new codes are used to report intermediate and intensive smoking and tobacco cessation counseling services provided to Medicare beneficiaries:
Smoking and tobacco use cessation counseling is considered reasonable and necessary for those Medicare beneficiaries who:
Claims for cessation counseling services should include the diagnosis reflecting the patient's condition being affected by the tobacco use or smoking, or the condition of a patient who is receiving a therapeutic agent whose metabolism or dosing of the agent is affected by tobacco use or smoking. Appropriate documentation should support the counseling services rendered and reported to Medicare. CMS will cover two separate cessation attempts within a 12-month period. Each cessation attempt can consist of intensive or intermediate counseling sessions; however, each attempt must not exceed four sessions. Therefore, no more than eight sessions are covered in a 12-month period.
More information on CMS's national coverage of smoking and tobacco use cessation counseling is available in Medicare's National Coverage Determinations Manual, Section 210.4 (www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp). To learn more about billing for these services, go to Medicare's Medlearn Matters article MM3834 at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3834.pdf.
From the Public Health Service and Surgeon General (www.surgeongeneral.gov/tobacco)
From the National Cancer Institute (http://smokefree.gov/hp-hcsit.html)
Although reimbursement for tobacco cessation services by other public and private payers is inconsistent, there are resources that provide some guidance on which states provide coverage under Medicaid as well as states with mandated coverage for tobacco treatment and/or counseling. The Centers for Disease Control published a report in the January 30, 2004, issue of Morbidity and Mortality Weekly on “State Medicaid Coverage for Tobacco Dependence Treatments, 1994-2002,” which provides a breakdown of coverage by state and type of coverage. In addition, the Professional Assisted Cessation Therapy (PACT) has a publication on Reimbursement for Smoking Cessation Therapy, which offers information on how clinicians may obtain reimbursement for such services. PACT is a consortium of leaders in the treatment of tobacco dependence. The publication is available at www.endsmoking.org.