Medicare Proposes 19% Pay Bump for Quit-Smoking Counseling
SkimNews Take
A 19% pay bump tied to cessation counseling signals Medicare is wielding fee-schedule design as a public-health lever — conceding that under-priced time, not lack of evidence, has been what kept this advice from becoming routine.
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- CMS proposed a 19% increase in reimbursement for tobacco cessation counseling — and the same adjustment for alcohol and substance misuse interventions — in its 1,592-page physician fee schedule released this week, with public comments due Sept. 14.
- Ned Sharpless, former NCI director now at UNC, said doctors currently receive roughly $10 per visit for cessation counseling; while "nobody's getting rich off this," the bump would bring the service "more on par with other activities."
- Medicare and Medicaid cover about 2 in 5 Americans and private insurers tend to follow their lead, so the proposed change could extend to employer-sponsored and individual plans, Sharpless said.
- CDC 2022 data shows just 5% of people who recently tried to quit received both behavioral counseling and medication combined, even though pairing the two significantly boosts success rates versus the under-10% quit rate for those who go it alone.
- Adam Goldstein at UNC warned the dollar increase alone won't be enough to push practices toward comprehensive cessation services — he'd want it paired with EHR prompts, standing medication protocols, quitline referrals, and follow-up.
- Anne DiGiulio of the American Lung Association called the prioritization of cessation reimbursement "long overdue," while Tim Clement of Mental Health America said the impact on alcohol screenings remains unclear since low pay is "certainly a factor" but not the only barrier.
- A Medicaid-claims survey across 20 states found just 2.7% of smokers who recently tried to quit received cessation counseling, and one study found only 5% of people with alcohol use disorder were given referrals or told about treatment options after a brief intervention.
Why it matters: Doctors have long had a financial disincentive to spend more than a sentence telling patients to quit — roughly $10 for counseling that actually works means most skip it. A 19% bump is modest in absolute dollars (around $2 more per visit) but it sends a signal to private insurers covering the remaining 60% of Americans that cessation is a billable clinical service, potentially nudging primary care toward structured quit-plans with counseling plus medication rather than the current "You should quit" default.
