Knowledge Base Article

Did you Know?

November is Lung Cancer Awareness Month and annually the American Cancer Society has designated the third Thursday of November as the Great American Smokeout®.

Why it Matters?

The American Cancer Society indicates that this event is important because “about 34 million American adults still smoke cigarettes, and smoking remains the single largest preventable cause of death and illness in the world. Smoking causes an estimated 480,000 deaths every year, or about 1 in 5 deaths.”

What Can You do About It?

For health care providers, know what resources are available for your patients.

Counseling to Prevent Tobacco Use

This service falls in the benefit category of additional preventive services and National Coverage Determination (NCD 210.4.1) Counseling to Prevent Tobacco Abuse details the covered indications for this service. Specifically, CMS covers this service for outpatient and hospitalized patients with Medicare Part B who meet the following criteria:

• The patient uses tobacco, regardless of whether they exhibit signs and symptoms of tobacco-related disease,
• The patient is competent and alert when counseling is delivered, and
• The counseling is provided by a qualified physician or other Medicare-recognized practitioner.

Counseling Frequency

Medicare covers two cessation attempts per year and each attempt may include a maximum of four intermediate or intensive sessions, with the patient getting up to eight sessions per year. There is no copayment, coinsurance, or deductible for the patient.

Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (NCD 210.14)

Lung Cancer Screening also falls in the benefit category of additional preventive services. Screening is covered for patients with Medicare Part B who meet all the following categories:

• The patient is 50 – 77 years of age,
• The patient is asymptomatic,
• The patient has a smoking history of at least 20 pack-years (1 pack-year = smoking 1 pack per day for 1 year, 1 pack + 20 cigarettes),
• Is a current smoker or quit smoking within the last fifteen years, and
• The physician orders the lung cancer screening with LDCT.

Screening Frequency

Medicare will cover this service annually. Of note, before the first lung cancer LDCT screening, the physician must counsel the patient as a shared decision-making visit. Like counseling to prevent tobacco use, the patient has no copayment, coinsurance, or deductible.

Resource:

CMS MLN Educational Tool Medicare Preventive Services (link)