Jimmie Hebert
CMC, CMIS, CMOM

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January 5, 2009

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  • Medicare’s Advanced Beneficiary Notice
  • Medicare’s Smoking and Tobacco Use Cessation Benefit
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Medicare’s Smoking and Tobacco Use Cessation Benefit

Over 400,000 smokers die each year from smoke related diseases. About 300,000 of those are Medicare patients age 65 and older. Research shows that about 10% of the total program costs for Medicare for 1997 were related to smoking. The U.S. Surgeon General has reported that quitting smoking leads to significant risk reduction and other health benefits even in older people who have smoked for years.

Medicare has a benefit that began on March 22, 2005 that can help beneficiaries ‘kick the habit’. This benefit is available to beneficiaries who have an illness caused by or complicated by tobacco use. These illnesses make up the bulk of the Medicare expenditures today, according to Medicare. Beneficiaries who take medication whose effectiveness is complicated by tobacco use are eligible for this benefit. Medications including insulin and some meds used to treat high blood pressure, blood clots and depression are examples. Illnesses such as heart disease, cerebrovascular disease, multiple cancers, lung disease, weak bones, blood clots and cataracts are examples of those that can get coverage for smoking and tobacco use cessation.

Medicare pays for two cessation attempts per year. Each attempt includes four intermediate (3-10 minutes each) or intensive sessions (longer than 10 minutes each) up to eight sessions in a twelve month period. Medicare recognizes HCPCS codes G0375 and G0376 for these visits. The diagnoses are carrier specific. The co-pay/co-insurance and deductible do apply for this benefit.

Your office may be losing out on some reimbursement if you are performing theses services and not charging Medicare for them. HCPCS code G0375 will reimburse from about $11.00 up to over $13.00, depending on the locality, for the 3-10 minute counseling session. G0376 reimburses between $21.00 and $28.00, depending on the locality, for a counseling session over 10 minutes. Physicians and other Medicare-recognized providers can provide these counseling services.

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