This webpage was published to help provide you with basic answers to common questions related to the Center for Medicare Services' benefits for tobacco-use cessation counseling sessions.
While we at the Nicotine Freedom System website have tried to be as comprehensive as possible in creating this FAQ resource, it may not answer all your questions. If you have a question that is not covered in this FAQ, please feel free to post a question to the ATTUD ListServ at: attud@umdnj.org (the website from which these questions and answers were replicated). You also can contact any of the resources listed in Question #7, below.
- What is the Medicare benefit for tobacco counseling?
- Does this mean any smoker or tobacco user 65 or older can receive treatment for tobacco dependence?
- Which providers are authorized by Medicare to receive payment for services?
- What is the billing code?
- What is the fee schedule for this new benefit?
- What forms and codes do you need to use to bill for this service?
- Where can I find more information about this benefit?
Q1. What is the Medicare benefit for tobacco counseling?
A: As of March 22, 2005, Medicare Part B covers 2 new levels of counseling: intermediate, which covers tobacco-use cessation counseling from 3-10 minutes in duration, and intensive, which covers tobacco-use cessation counseling greater than 10 minutes. Coverage includes 2 attempts per year, each with a maximum of 4 intermediate or intensive sessions (a total of 8 sessions per 12 month period).
Q2. Does this mean any smoker or tobacco user 65 or older can receive treatment for tobacco dependence?
A: No. Coverage is limited to those tobacco users who have a “disease or adverse health effect caused or complicated by tobacco use” may take advantage of this new benefit. It also covers tobacco users who are being “treated with a therapeutic agent whose metabolism or dosing is affected by the use of tobacco.” (Medlearn Matters Number MM3834, http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3834.pdf) Click on the titles to view Diseases and Health Effects Related to Smoking and Drug Interactions with Smoking.
Q3. Which providers are authorized by Medicare to receive payment for services?
A: Physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified nurse midwifes, clinical psychologists, clinical social workers, physical therapists and occupational therapists “all have their own benefit categories and may provide services without direct physician supervision and bill directly for these services,” as long as the provider is legally authorized to perform services in the states in which they are furnished. (Medicare Benefit Policy Manual, Chapter 15, Section 60A.) We are not sure yet if these non-physician providers may in fact bill for tobacco counseling under their own name, but it appears so based on this excerpt from the Medicare Benefit Policy Manual.
A: G0376 for moderate counseling; Short descriptor: Smoke/Tobacco counseling 3-10.
G0376 for intensive counseling; Short descriptor: Smoke/Tobacco counseling greater than 10.
Q5. What is the fee schedule for this benefit?
A: Currently, the national average rate for Moderate Counseling (3-10 minutes), Code G0375, is $12.89, and the national average rate for Intensive Counseling (over 10 minutes), Code G0376, is $25.39. This rate varies according to geographic location. For rates specific to your area, contact your local Medicare carrier. (To view a list of state carriers, go to www.pueblo.gsa.gov/cic_text/fed_prog/medicare/mhbkc05.htm.) CMS is expected to post these rates and ask for public comment. Often rates are adjusted upwards if there is evidence to support a higher rate (e.g. significant training requirements in order to provide the service)
Q6. What forms and codes do you need to use to bill for this service?
A: According to CMS, “smoking and tobacco use cessation counseling claims are to be submitted with the appropriate diagnosis code. Diagnosis codes should reflect the condition the patient has that is adversely affected by the use of tobacco or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by the use of tobacco”. (MedlearnMatters No MM3834)
Q7. Where can I find more information about this benefit?
- To view the draft decision memo that provides background information on this benefit go to www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=130
- To view a brochure produced by CMS about the smoking cessation counseling benefit, go to http://www.cms.hhs.gov/MLNproducts/downloads/smoking.pdf
- For CMS information on the benefit and how to bill Medicare for delivering tobacco cessation counseling services, you can visit the links below. Please note that these documents have NOT necessarily been revised to reflect the new CPT codes:
- To find your state carrier and local Peer Review Organizations (PROs), go to this webpage: http://www.pueblo.gsa.gov/cic_text/fed_prog/medicare/mhbkc05.htm