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?

In June of this year HHS published a request for information in the Federal Register seeking input on the Draft HHS 2023 Framework to Support and Accelerate Smoking Cessation to guide the Department’s efforts to sustain and strengthen existing programs and drive further progress toward smoking cessation, with an emphasis on serving populations and communities disproportionately impacted by smoking-related morbidity and mortality. Comments had to be submitted by July 30, 2023. https://www.federalregister.gov/documents/2023/06/30/2023-13928/request-for-information-draft-hhs-2023-framework-to-support-and-accelerate-smoking-cessation

In a related Fact Sheet, HHS noted that “smoking causes approximately 30 percent of all cancer deaths in the nation – making it the largest single driver of cancer deaths in America…the Biden-Harris administration has made it a priority to reach the Cancer Moonshot goal of reducing cancer mortality by 50% within 25 years. Driving progress towards smoking cessation is essential to achieving this goal.”

What Can I 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. 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 eligibility criteria:  

• 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 beneficiary must receive a counseling and shared decision-making visit that meets the following criteria and is appropriately documented in the beneficiary’s medical record:

• Determination of beneficiary eligibility,
• Shared decision-making including the use of one or more decision aids,
• Counseling on the important of adherence to annual lung cancer LDCT screening, impact of comorbidities and ability or willingness to undergo diagnosis and treatment, and
• Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cession if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions.

Like counseling to prevent tobacco use, the patient has no copayment, coinsurance, or deductible.

Resources

HHS Fact Sheet: HHS Released Draft Framework to Accelerate Efforts to Help Americans Avoid and Quit Smoking: https://www.hhs.gov/about/news/2023/06/29/fact-sheet-hhs-releases-draft-framework-accelerate-efforts-help-americans-avoid-and-quit-smoking.html

NCD 210.4.1 Counseling to Prevent Tobacco Use: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=342

CMS MLN Educational Tool Medicare Preventive Services: (https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#TOBACCO)