UM Guidelines

This Supplemental Utilization Management Guideline will be Archived in favor of CMS, NCD - Counseling to Prevent Tobacco Use (210.4.1).

	Added: Clinical Indications for Counseling:
	Counseling to prevent tobacco use may be covered for ALL of the following: Uses tobacco, regardless of whether he or she has signs or symptoms of tobacco-related disease Is competent and alert at time that counseling is provided Counseling is furnished by qualified physician or practitioner Services are appropriate for 2 individual attempts per 12-month period [A] session attempts per year

References

1. BlueCross BlueShield of Tennessee network physicians. July - September 2024.

2. Centers for Medicare & Medicaid Services. CMS.gov. NCD for smoking and tobacco-use cessation counseling (210.4.1). Retrieved August 2, 2024 from https://www.cms.gov.

Footnotes

[A] Each attempt may include a maximum of 4 intermediate or intensive sessions, with a total of up to 8 sessions per 12-month period. The practitioner and patient have the flexibility to choose between intermediate (more than 3 minutes but less than 10 minutes), or intensive (more than 10 minutes) cessation counseling sessions for each attempt.