■ Intermediate (greater than 3 minutes and less than 10 minutes); or
■ Intensive (greater than 10 minutes).
Cessation counseling sessions may be performed “incident to” the services of a qualified practitioner. During the 12-month period, the practitioner and the beneficiary have flexibility to choose between intermediate or intensive counseling for each session.
DOCUMENTATION Medical record documentation must show, for each Medicare beneficiary for whom a smoking and tobacco-use cessation counseling or counseling to prevent tobacco use claim is made, standard information along with sufficient beneficiary history to adequately demonstrate
COVERAGE INFORMATION Medicare provides coverage of smoking and tobacco-use cessation counseling services for outpatient and hospitalized beneficiaries who meet the following criteria:
■ Who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco-related disease; or
■ Who use tobacco (regardless of whether they have signs or symptoms of tobacco-related disease);
Additional coverage criteria:
■ Beneficiaries must be competent and alert at the time that counseling services are provided; and
■ Counseling is furnished by a qualified physician or other Medicare-recognized practitioner.
Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive counseling sessions. The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period.
The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare-covered cessation counseling session was performed. Example: The beneficiary received the first of eight covered sessions in January 2011. The count starts beginning February 2011. The beneficiary is eligible to receive a second series of eight sessions in January 2012.
Medicare’s prescription drug benefit also covers smoking and tobacco-use cessation agents prescribed by a physician. Eligible beneficiaries are covered under Medicare Part B. Both the coinsurance and deductible are waived. NOTE: Medicare covers minimal cessation counseling (defined as 3 minutes or less in duration) as part of each Evaluation and Management visit, and it is not separately billable.
CESSATION COUNSELING ATTEMPT 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 with a cessation counseling attempt. A cessation counseling attempt includes the following:
■ Up to four cessation counseling sessions (one attempt = up to four sessions)
■ Two cessation counseling attempts (or up to 8 cessation counseling sessions) are allowed every 12 months.
CESSATION COUNSELING SESSION A cessation counseling session refers to face-to-face patient contact at one of two levels.