The Centers for Medicare and Medicaid Services has proposed increasing reimbursement by 19% for physicians who provide counseling on tobacco cessation, alcohol misuse screening, and substance use interventions during patient visits. The proposal, contained in a 1,592-page physician fee schedule document released this week, would apply the same adjustment across these three service categories. The agency cited evidence supporting these services’ role in preventing and managing chronic disease, noting that current valuation does not adequately reflect the clinical intensity and work involved in these time-based services. A public comment period on the proposal is scheduled to close Sept. 14.
Currently, doctors receive approximately $10 for tobacco cessation counseling, a reimbursement rate that experts say fails to incentivize adequate attention to the issue despite its significance as the nation’s leading cause of preventable death. The proposed increase would bring compensation more in line with other clinical activities, though observers note the absolute dollar gain per visit may remain modest. Private insurers typically follow Medicare and Medicaid payment policies, meaning any approved changes could influence coverage for roughly 2 in 5 Americans, potentially extending benefits beyond the Medicare and Medicaid populations.
Data reveals substantial gaps in current cessation support. According to 2022 Centers for Disease Control and Prevention data, only 5% of people who recently attempted to quit smoking received both counseling and medication, despite evidence showing significantly higher success rates when these two approaches are combined. Unassisted quit attempts succeed at rates below 10%, while structured interventions incorporating behavioral support and pharmacological treatments achieve substantially better outcomes. A Medicaid claims survey across 20 states found that only an average 2.7% of smoking patients who had recently attempted to quit received cessation counseling.
Experts emphasize that even brief physician advice can improve quit rates, yet many patients receive only general recommendations rather than comprehensive treatment plans. Ideally, physicians should conduct structured conversations addressing patient motivation, potential triggers, and relevant medications while providing ongoing follow-up support. Some researchers advocate for integrating tobacco treatment specialists into healthcare practices, similar to existing diabetes educator models, to provide consistent monitoring that individual physicians cannot practically deliver through frequent check-ins.
While observers view the reimbursement increase as a meaningful step, questions remain about whether the adjustment alone will drive comprehensive service adoption without accompanying systemic changes such as electronic health record prompts, trained specialists, and coordinated referral systems. The impact on alcohol and substance use screening and intervention uptake also remains uncertain, though low reimbursement has been identified as a contributing factor to underutilization of these services across clinical settings.