Counseling to Prevent Tobacco Use

Over the past 25 years, the Congress has added coverage of specific preventive and screening services to the Medicare Part B program such as Pap smear and screening pelvic exams, screening mammograms, colorectal cancer screening tests, and diabetes screening tests. Effective January 1, 2009, CMS is allowed to add coverage of "additional preventive services" if certain statutory requirements are met, as provided under section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). Specifically, this new benefit allows CMS under 42 CFR 410.64 to cover "additional preventive services" not otherwise described in Title XVIII of the Act, if it determines through the NCD process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and meets certain other requirements.

After reviewing various preventive services given a grade A or grade B recommendation by the USPSTF, CMS has decided to initiate a new national coverage analysis (NCA) on counseling to prevent tobacco use, focusing upon asymptomatic adults and pregnant women who use tobacco products. At present, Medicare Part B covers smoking and tobacco use cessation counseling as described in section 210.4 of the NCD Manual, which only provides for treatment of individuals who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco-disease.

This new NCA will evaluate the available evidence regarding counseling to prevent tobacco use in asymptomatic Medicare beneficiaries, i.e., those without recognized signs or symptoms of tobacco-related disease, and will determine if a new national coverage determination is warranted.

November 30, 2009

May 28, 2010

August 25, 2010