CMS Pub. 100-03, ch. 1, § 210.4.1

A. General

Tobacco use remains the leading cause of preventable morbidity and mortality in the U.S. and is a major

contributor to the nation’s increasing medical costs. Despite the growing list of adverse health effects

associated with smoking, more than 45 million U.S. adults continue to smoke and approximately 1,200 die

prematurely each day from tobacco-related diseases. Annual smoking-attributable expenditures can be

measured both in direct medical costs ($96 billion) and in lost productivity ($97 billion), but the results of

national surveys have raised concerns that recent declines in smoking prevalence among U.S. adults may

have come to an end. According to the U.S. Department of Health and Human Services (DHHS) Public

Health Service (PHS) Clinical Practice Guideline on Treating Tobacco Use and Dependence (2008), 4.5

million adults over 65 years of age smoke cigarettes. Even smokers over age 65, however, can benefit

greatly from abstinence, and older smokers who quit can reduce their risk of death from coronary heart

disease, chronic obstructive lung disease and lung cancer, as well as decrease their risk of osteoporosis.

B. Nationally Covered Indications

Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation

counseling for outpatient and hospitalized Medicare beneficiaries

1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;

2. Who are competent and alert at the time that counseling is provided; and,

3. Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

Intermediate and intensive smoking cessation counseling services will be covered under Medicare Part B

when the above conditions of coverage are met, subject to frequency and other limitations. That is, similar to

existing tobacco cessation counseling for symptomatic individuals, CMS will allow 2 individual tobacco

cessation counseling attempts per 12-month period. Each attempt may include a maximum of 4 intermediate

OR intensive sessions, with a total benefit covering up to 8 sessions per 12-month period per Medicare

beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between

intermediate (more than 3 minutes but less than 10 minutes), or intensive (more than 10 minutes) cessation

counseling sessions for each attempt.

C. Nationally Non-Covered Indications

Inpatient hospital stays with the principal diagnosis of tobacco use disorder are not reasonable and necessary

for the effective delivery of tobacco cessation counseling services. Therefore, we will not cover tobacco

cessation services if tobacco cessation is the primary reason for the patient’s hospital stay.

D. Other

Section 4104 of the Affordable Care Act provided for a waiver of the Medicare coinsurance and Part B

deductible requirements for this service effective on or after January 1, 2011. Until that time, this service

will continue to be subject to the standard Medicare coinsurance and Part B deductible requirements.

(This NCD last reviewed December 2016.)