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Medicare Coverage: Tobacco Use Cessation Policy Updates

July 28, 2011: Cessation: Emerging Interventions and Innovations

Jyme Schafer, M.D., M.P.H., Division Director, Coverage and Analysis Group, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services

Dr. Schafer provided a brief history and status of Medicare's statutory mandates for preventive services with the most recent being the 2010 Affordable Care Act. This legislation includes coverage for an annual wellness visit and the waiver of the deductible for U.S. Preventive Services Task Force Grade A or B services for asymptomatic beneficiaries receiving smoking and tobacco-use counseling services. A cessation counseling attempt occurs when a qualified physician or other Medicare-recognized practitioner determines that a beneficiary meets the eligibility requirements and initiates treatment. The coverage includes up to four cessation counseling sessions per attempt and two cessation counseling attempts (or up to eight sessions) are allowed every 12 months. These sessions refer to face-to-face patient contact at one of two levels: intermediate (greater than three months and less than ten minutes) or intensive (greater than ten minutes). In addition, the Medicare Prescription Drug and Modernization Act of 2003 required that smoking cessation treatments prescribed by a physician be covered as of January 2006. Over-the-counter treatments such as nicotine patches and gum are not covered.

Dr. Schafer concluded with resource websites:
and [PDF–1.22 MB]

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