Georgia Medicare Tobacco Cessation Counseling 2026

By Brevy Care Team · Last verified May 14, 2026

The Medicare tobacco use cessation counseling benefit gives every eligible Georgia Medicare beneficiary who uses tobacco the right, twice each year, to a structured course of four face-to-face counseling sessions with a qualified provider focused on helping the beneficiary quit tobacco use. Eight total sessions across two cessation attempts per twelve-month period, billed under CPT 99406 for intermediate counseling visits lasting three to ten minutes or CPT 99407 for intensive counseling visits lasting longer than ten minutes, at zero cost-sharing to the beneficiary under the Affordable Care Act Section 4104 preventive services cost-sharing waiver. Coordinated with comprehensive Part D pharmacotherapy coverage for the seven FDA-approved tobacco cessation aids: five nicotine replacement therapy formulations (transdermal patches, gum, lozenges, inhaler, nasal spray), bupropion sustained-release, and varenicline. The benefit reflects the United States Preventive Services Task Force 2021 Grade A recommendation that clinicians ask all adults about tobacco use, advise tobacco users to stop, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation.

The Medicare tobacco cessation counseling benefit has a layered legislative history that distinguishes it from most other Medicare preventive services. The original tobacco cessation counseling benefit was established under Section 1861(s)(2)(HH) of the Social Security Act, effective March 22, 2005, but coverage was limited to beneficiaries who had been diagnosed with a tobacco-related disease or who exhibited signs or symptoms of a tobacco-related disease, or who were taking a medication whose metabolism or dosing was affected by tobacco use. The original Section 1861(s)(2)(HH) benefit therefore covered roughly the subset of tobacco-using beneficiaries who were already manifesting illness — a framework that did not align with the prevention-oriented spirit of behavioral counseling for tobacco cessation.

That limitation was rectified through a CMS coverage decision in 2010. Effective August 25, 2010, CMS issued a national coverage determination — codified as NCD 210.4.1 — that expanded tobacco cessation counseling coverage to all tobacco-using Medicare beneficiaries regardless of whether they had been diagnosed with or showed signs of tobacco-related disease. The August 25, 2010 expansion brought the Medicare tobacco cessation counseling benefit into alignment with the USPSTF recommendation framework and with the broader prevention-oriented philosophy of the additional preventive services authority under Section 1861(ddd) of the Social Security Act added by the Medicare Improvements for Patients and Providers Act of 2008.

The structure of the benefit reflects clinical evidence about what produces successful tobacco cessation. Coverage is structured as two cessation attempts per twelve-month period, each cessation attempt comprising up to four counseling sessions, for a total of up to eight sessions per twelve-month period. This structure reflects clinical reality: tobacco cessation is rarely a single-attempt success, most successful quitters require multiple cessation attempts across years of efforts, and structured behavioral counseling combined with FDA-approved pharmacotherapy substantially improves cessation outcomes compared with either intervention alone.

The benefit is billed under one of two CPT codes depending on the counseling encounter's duration. CPT 99406 covers intermediate counseling visits lasting three to ten minutes. CPT 99407 covers intensive counseling visits lasting longer than ten minutes. The shorter intermediate visit reflects the time required to deliver brief tobacco cessation counseling in a typical primary care encounter following the evidence-based "5 A's" framework (Ask, Advise, Assess, Assist, Arrange). The longer intensive visit reflects the time required to deliver more comprehensive cessation counseling including motivational interviewing using the "5 R's" framework (Relevance, Risks, Rewards, Roadblocks, Repetition) for beneficiaries who are not yet ready to quit, structured behavioral skills training for those who are ready to quit, and detailed pharmacotherapy planning.

The cost-sharing structure is zero out-of-pocket for the beneficiary. The Affordable Care Act Section 4104 cost-sharing waiver effective January 1, 2011 eliminates the Part B deductible and the twenty percent coinsurance for Medicare preventive services aligned with USPSTF Grade A and Grade B recommendations and specifically designated by CMS. Tobacco cessation counseling under both CPT 99406 and CPT 99407 is among the preventive services covered under the waiver, so for Georgia Medicare beneficiaries the counseling visits are zero cost.

The Part D pharmacotherapy coordination is structured separately. Prior to the Medicare Modernization Act of 2003, Medicare did not cover outpatient prescription drugs broadly, and tobacco cessation pharmacotherapy was therefore an out-of-pocket cost for most beneficiaries except where covered through Medicaid for dual-eligible beneficiaries or through retiree drug coverage. The Medicare Modernization Act of 2003 (Public Law 108-173) established Medicare Part D effective January 1, 2006, and Part D plans are required to cover all seven FDA-approved tobacco cessation pharmacotherapy aids on their formularies. The seven FDA-approved aids are five forms of nicotine replacement therapy (transdermal patches, polacrilex gum, polacrilex lozenges, oral inhaler, and nasal spray), bupropion sustained-release (Zyban / generic), and varenicline (Chantix / generic). Part D formularies include these medications, though specific formulary placement, prior authorization, and tier assignment vary by plan.

For Georgia Medicare beneficiaries, the tobacco cessation counseling benefit operates within a state landscape that includes elevated tobacco use prevalence particularly in rural counties, substantial tobacco-related morbidity and mortality including elevated lung cancer and chronic obstructive pulmonary disease rates, and substantial tobacco control infrastructure. The Georgia Tobacco Quit Line provides telephone-based cessation counseling at 1-877-270-7867 with telephone counseling, web-based programs, and nicotine replacement therapy starter kits for eligible callers. The Georgia Department of Public Health Tobacco Use Prevention Program coordinates state-level tobacco control. The American Lung Association Georgia provides Freedom From Smoking group and online cessation programs. Emory and other Georgia academic medical centers run dedicated tobacco cessation programs that integrate intensive counseling with pharmacotherapy management.

This guide explains how the Medicare tobacco use cessation counseling benefit works statutorily and clinically, what eligibility looks like, how the eight-session-per-twelve-month framework operates across two cessation attempts, what the intermediate versus intensive CPT 99406 and CPT 99407 counseling codes represent, how Part D pharmacotherapy coverage coordinates with the counseling benefit, how the benefit coordinates with the Annual Wellness Visit and Initial Preventive Physical Examination tobacco screening components, how it coordinates with Medicare lung cancer screening under low-dose CT NCD 210.14 for tobacco-using beneficiaries who meet eligibility criteria, what the Georgia Tobacco Quit Line provides as a complementary service, and what the Georgia tobacco control landscape looks like for beneficiaries seeking comprehensive cessation support.

Key Takeaways for Georgia Medicare Beneficiaries

1. Section 1861(s)(2)(HH) of the Social Security Act originally established Medicare tobacco cessation counseling coverage effective March 22, 2005, but limited to beneficiaries with tobacco-related disease or signs/symptoms of tobacco-related disease, or taking medication affected by tobacco use.

2. Section 1861(ddd) of the Social Security Act and NCD 210.4.1 expanded tobacco cessation counseling coverage to all tobacco-using beneficiaries regardless of tobacco-related disease status, effective August 25, 2010. The expansion brought Medicare into alignment with the USPSTF Grade A recommendation framework for tobacco cessation interventions.

3. Coverage structure is up to eight counseling sessions per twelve-month period, organized as two cessation attempts of up to four sessions each per twelve-month period.

4. CPT 99406 (intermediate, 3-10 minutes) and CPT 99407 (intensive, greater than 10 minutes) are the billing codes. The shorter intermediate code reflects brief counseling delivered following the 5 A's framework. The longer intensive code reflects comprehensive counseling including motivational interviewing using the 5 R's framework for beneficiaries not yet ready to quit.

5. ACA Section 4104 waives the Part B deductible and the 20% coinsurance for tobacco cessation counseling under both CPT 99406 and CPT 99407. Cost-sharing is zero out-of-pocket.

6. Part D pharmacotherapy coordination under the Medicare Modernization Act 2003 covers all seven FDA-approved tobacco cessation aids: five forms of nicotine replacement therapy (transdermal patches, polacrilex gum, polacrilex lozenges, oral inhaler, nasal spray), bupropion sustained-release, and varenicline.

7. USPSTF 2021 Grade A tobacco cessation intervention recommends clinicians ask all adults about tobacco use, advise tobacco users to stop, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation in adults who use tobacco.

8. AWV and IPPE tobacco screening coordination: The Annual Wellness Visit and Initial Preventive Physical Examination both include tobacco use screening as a required component. Tobacco use identified during these visits can be coordinated directly into the tobacco cessation counseling benefit.

9. Lung cancer screening coordination under NCD 210.14 provides annual low-dose CT screening for current and former tobacco users meeting eligibility criteria (age 50-77, 20+ pack-year smoking history, current smoker or quit within prior 15 years). Tobacco cessation counseling integrates with lung cancer screening referral.

10. For Georgia beneficiaries, the benefit operates within a state landscape that includes Georgia Tobacco Quit Line (1-877-270-7867) telephone counseling, Georgia DPH Tobacco Use Prevention Program, American Lung Association Georgia Freedom From Smoking programs, and major academic tobacco cessation programs at Emory and other Georgia medical centers. Georgia tobacco use prevalence remains elevated particularly in rural counties and among certain demographic populations.

The Federal Framework Underlying the Medicare Tobacco Cessation Counseling Benefit

Section 1861(s)(2)(HH) of the Social Security Act — Original Tobacco Cessation Counseling Authority

The Medicare tobacco cessation counseling benefit was originally established under Section 1861(s)(2)(HH) of the Social Security Act, codified at 42 U.S.C. 1395x(s)(2)(HH), effective March 22, 2005. The original Section 1861(s)(2)(HH) authority enumerated tobacco cessation counseling as a Part B benefit, but coverage was structured around tobacco-related disease eligibility. Specifically, coverage was available to beneficiaries who had been diagnosed with a tobacco-related disease (lung cancer, COPD, cardiovascular disease, certain other malignancies, peripheral vascular disease, or other conditions where tobacco use is a documented contributor), who exhibited signs or symptoms of a tobacco-related disease, or who were taking a medication whose metabolism or dosing was affected by tobacco use (warfarin, theophylline, certain antipsychotics, certain antidepressants, and others).

The Section 1861(s)(2)(HH) framework reflected a particular policy view that Medicare tobacco cessation counseling should focus resources on beneficiaries already manifesting tobacco-related illness, rather than covering all tobacco-using beneficiaries as a primary prevention measure. This framework had significant practical limitations because tobacco-using beneficiaries without diagnosed tobacco-related disease — the majority of Medicare tobacco users — were not covered, leaving a substantial gap in primary prevention.

Section 1861(ddd) of the Social Security Act — Additional Preventive Services Authority

The Section 1861(s)(2)(HH) limitation was substantially addressed through the additional preventive services authority added under Section 1861(ddd) of the Social Security Act, codified at 42 U.S.C. 1395x(ddd), and added by Section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, Public Law 110-275). The Section 1861(ddd) authority enables CMS to cover additional preventive services through national coverage determination if the services meet three criteria: reasonable and necessary for the prevention or early detection of illness or disability, recommended with a Grade A or Grade B by the USPSTF, and appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

The Section 1861(ddd) authority was used to add the tobacco cessation counseling expansion to cover all tobacco-using beneficiaries regardless of tobacco-related disease status, alongside other behavioral counseling preventive services added in 2010-2011 (alcohol misuse screening, depression screening, STI screening, IBT for cardiovascular disease, IBT for obesity).

NCD 210.4.1 — Expanded Tobacco Cessation Counseling Coverage

Effective August 25, 2010, CMS issued the national coverage determination expanding tobacco cessation counseling coverage to all tobacco-using Medicare beneficiaries. NCD 210.4.1 established the following coverage framework:

• Eligibility: All tobacco-using Medicare beneficiaries regardless of whether they have been diagnosed with or exhibit signs or symptoms of a tobacco-related disease.
• Frequency: Up to eight counseling sessions per twelve-month period, organized as up to two cessation attempts per twelve-month period, each cessation attempt comprising up to four counseling sessions.
• Counseling codes: CPT 99406 (intermediate, 3-10 minutes) and CPT 99407 (intensive, greater than 10 minutes).
• Provider: Any Medicare-enrolled physician or other Medicare-recognized practitioner authorized to furnish the service (MD, DO, NP, PA, CNS, clinical psychologist where furnished as part of qualifying services).
• Setting: Outpatient settings (primary care, specialty practice, FQHC, RHC, outpatient hospital).

42 CFR 410.64 — Additional Preventive Services Implementing Regulations

The Section 1861(ddd) authority is implemented through 42 CFR 410.64, which incorporates the NCD 210.4.1 expansion framework for tobacco cessation counseling. The regulation defines the once-per-twelve-month cessation attempt limit, the four-session-per-cessation-attempt limit, the two-attempt-per-twelve-month limit (and consequently the eight-total-session-per-twelve-month framework), and the CPT 99406/99407 coding structure.

USPSTF Tobacco Cessation Intervention Grade A Recommendation

The clinical evidence basis for the tobacco cessation counseling benefit is the USPSTF Grade A recommendation that clinicians ask all adults about tobacco use, advise tobacco users to stop, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to adults who use tobacco. The recommendation was originally issued in 2009, then updated and reaffirmed in 2015, then most recently updated in 2021. The 2021 update maintained the Grade A recommendation for non-pregnant adult tobacco users, with a separate Grade A recommendation for pregnant tobacco users (relevant for younger Medicare-eligible populations qualifying through SSDI or ESRD). The 2021 update also addressed electronic cigarette use as a cessation aid: the USPSTF concluded the evidence was insufficient (I statement) to recommend electronic cigarettes for tobacco cessation in non-pregnant adults.

ACA Section 4104 Cost-Sharing Waiver

Section 4104 of the Affordable Care Act (Public Law 111-148, March 23, 2010) waives the Part B deductible and the twenty percent coinsurance for Medicare preventive services aligned with USPSTF Grade A or Grade B recommendations and specifically designated by CMS. The waiver is effective January 1, 2011. Tobacco cessation counseling under CPT 99406 and CPT 99407 is among the preventive services covered under the waiver because the underlying USPSTF recommendation is Grade A.

Medicare Modernization Act 2003 Part D Pharmacotherapy Coverage

The Medicare Modernization Act of 2003 (Public Law 108-173) established Medicare Part D effective January 1, 2006. Part D plans are required to cover all seven FDA-approved tobacco cessation pharmacotherapy aids on their formularies. Specifically:

• Nicotine replacement therapy (5 formulations): Transdermal patches (multiple strengths), polacrilex gum (2 mg and 4 mg), polacrilex lozenges (2 mg and 4 mg), oral inhaler, and nasal spray.
• Bupropion sustained-release (Zyban / generic) — a non-nicotine cessation aid with antidepressant properties at higher doses.
• Varenicline (Chantix / generic) — a nicotinic acetylcholine receptor partial agonist developed specifically for tobacco cessation.

Specific Part D formulary placement, prior authorization requirements, and tier assignment vary by plan and by year. The Inflation Reduction Act 2022 (Public Law 117-169) Section 11401 eliminated cost-sharing for Part D vaccines effective January 1, 2023, but did not separately address tobacco cessation pharmacotherapy cost-sharing — Part D copays and coinsurance still apply to tobacco cessation medications subject to the IRA Part D $2,000 out-of-pocket cap effective 2025.

The CPT 99406 and CPT 99407 Coding Framework

The Medicare tobacco cessation counseling benefit uses two CPT codes that differ in the duration of the counseling encounter:

CPT 99406 — Intermediate Tobacco Cessation Counseling (3-10 Minutes)

CPT 99406 is defined as "Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes." The intermediate code reflects brief tobacco cessation counseling typically delivered as part of a primary care encounter using the evidence-based "5 A's" framework:

• Ask about tobacco use at every visit.
• Advise every tobacco user to quit in a clear, strong, personalized manner.
• Assess the tobacco user's willingness to quit at this time.
• Assist the tobacco user with a quit plan, including pharmacotherapy recommendation, behavioral counseling, and quitline referral.
• Arrange follow-up contact within the first week after the quit date.

CPT 99406 documentation must support time spent in counseling (3-10 minutes face-to-face) and the content of the counseling (5 A's framework elements addressed). The visit may be furnished as a standalone counseling encounter or as a counseling component of a broader primary care visit.

CPT 99407 — Intensive Tobacco Cessation Counseling (Greater Than 10 Minutes)

CPT 99407 is defined as "Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes." The intensive code reflects comprehensive tobacco cessation counseling typically required for beneficiaries needing more extensive intervention, including motivational interviewing using the "5 R's" framework for beneficiaries who are not yet ready to quit:

• Relevance: Why is quitting personally relevant to the beneficiary's life and health?
• Risks: What are the personal risks of continued tobacco use?
• Rewards: What are the personal rewards of quitting?
• Roadblocks: What barriers does the beneficiary perceive to quitting?
• Repetition: Repeat the intervention at every clinical encounter with a tobacco user who is not yet ready to quit.

For beneficiaries who are ready to quit, the intensive counseling visit includes detailed pharmacotherapy planning (selecting among NRT, bupropion SR, varenicline, or combinations), structured behavioral skills training (identifying triggers, developing coping strategies, planning for withdrawal symptoms, planning for high-risk situations), setting a specific quit date, and arranging follow-up.

CPT 99407 documentation must support time spent in counseling (greater than 10 minutes face-to-face) and the comprehensive content addressed. The visit is typically scheduled as a dedicated counseling encounter rather than embedded in a broader primary care visit.

The Eight-Session-Per-Twelve-Month Framework

The benefit is structured as up to eight counseling sessions per twelve-month period, organized as two cessation attempts per twelve-month period of up to four sessions each:

• Cessation attempt structure: A cessation attempt is defined by a documented intention to quit tobacco use, with a quit date set (which may be the day of the first counseling session or scheduled for a near-future date). Each cessation attempt includes up to four counseling sessions distributed over the cessation attempt timeframe — typically the initial visit at the time the cessation attempt begins, follow-up visits at one week, four weeks, and three months after the quit date, though specific scheduling is at the provider's clinical discretion.
• Second cessation attempt: Beneficiaries who do not succeed in their first cessation attempt within a twelve-month period are eligible for a second cessation attempt of up to four additional counseling sessions in the same twelve-month period.
• Cumulative cap: The total cap is eight counseling sessions per twelve-month period, regardless of the timing of cessation attempts within the period.
• Renewal: A new twelve-month period begins twelve months after the first counseling session, restarting the eight-session counter.

Part D Tobacco Cessation Pharmacotherapy Coordination

The Medicare Part D pharmacotherapy framework for tobacco cessation, established under the Medicare Modernization Act 2003 effective January 1, 2006, covers all seven FDA-approved tobacco cessation pharmacotherapy aids. The coordination between Part B counseling under CPT 99406/99407 and Part D pharmacotherapy is a defining feature of Medicare tobacco cessation coverage because clinical evidence shows that combined behavioral counseling plus pharmacotherapy produces substantially higher cessation rates than either intervention alone.

Nicotine Replacement Therapy (Five Formulations)

Nicotine replacement therapy delivers controlled nicotine doses without the combustion-related toxins of tobacco products, allowing gradual nicotine taper while addressing withdrawal symptoms and cravings.

• Transdermal nicotine patches: 7 mg, 14 mg, and 21 mg formulations. Standard regimen for heavier smokers starts at 21 mg/24 hours for 6 weeks, then 14 mg for 2 weeks, then 7 mg for 2 weeks. Patches deliver steady nicotine levels throughout the day.
• Polacrilex gum: 2 mg and 4 mg formulations. The 2 mg gum is appropriate for those smoking fewer than 25 cigarettes per day; the 4 mg gum for heavier smokers. Gum is used on an as-needed basis for cravings, typically one piece every 1-2 hours.
• Polacrilex lozenges: 2 mg and 4 mg formulations. Similar dosing principles to gum, dissolved in the mouth.
• Oral inhaler: Nicotine delivered through a plastic cartridge inhaler, providing both nicotine replacement and behavioral substitution for the hand-to-mouth ritual of smoking.
• Nasal spray: Rapid nicotine delivery through nasal mucosa, providing the fastest pharmacokinetic onset of any NRT formulation.

Combination NRT — typically a transdermal patch for baseline nicotine replacement combined with gum, lozenges, or inhaler for breakthrough cravings — is supported by clinical evidence as more effective than single-formulation NRT.

Bupropion Sustained-Release

Bupropion sustained-release (Zyban / generic) is a non-nicotine pharmacotherapy initially developed as an antidepressant but found to support tobacco cessation through dopaminergic and noradrenergic effects. Standard regimen begins 150 mg daily for 3 days, then 150 mg twice daily, with the quit date set for 1-2 weeks after starting medication. Treatment is typically continued for 7-12 weeks total with possible extension. Contraindications include seizure disorder, eating disorders, and concurrent MAOI use.

Varenicline

Varenicline (Chantix / generic) is a nicotinic acetylcholine receptor partial agonist developed specifically for tobacco cessation. Varenicline reduces craving and withdrawal symptoms while reducing the reinforcing effects of nicotine in beneficiaries who continue to smoke during the cessation attempt. Standard regimen is titrated upward: 0.5 mg daily for 3 days, then 0.5 mg twice daily for 4 days, then 1 mg twice daily for 12 weeks. The quit date is typically set for 1 week after starting medication, allowing varenicline to reach steady-state. Treatment may be extended to 24 weeks total in beneficiaries who have quit but remain at high relapse risk.

Part D Formulary Coverage Considerations

Part D plans are required to cover all seven FDA-approved tobacco cessation pharmacotherapy aids on their formularies, but specific formulary placement (tier assignment), prior authorization requirements, and step therapy protocols vary by plan and year. The most cost-effective regimens for Georgia Medicare beneficiaries are typically generic combination NRT (generic patches plus generic gum or lozenges) or generic bupropion SR. Brand varenicline has generic available; generic varenicline is typically more affordable. Beneficiaries should consult their Part D plan formulary or contact GeorgiaCares SHIP at 1-866-552-4464 for plan-specific cost information.

Coordination With AWV and IPPE Tobacco Screening

The tobacco cessation counseling benefit coordinates with two other Medicare preventive services that include tobacco use screening as a required component:

Initial Preventive Physical Examination (IPPE) Tobacco Screening

The Initial Preventive Physical Examination, established under Section 1861(ww) of the Social Security Act effective January 1, 2005 and updated by the Medicare Improvements for Patients and Providers Act 2008, provides a once-in-a-lifetime "Welcome to Medicare" preventive visit available within the first twelve months of Medicare enrollment. The IPPE includes tobacco use screening as a required component along with screening for alcohol misuse, depression, and other health behaviors. Tobacco use identified during the IPPE can be coordinated directly into the tobacco cessation counseling benefit, with the IPPE counseling component flowing into a structured cessation attempt under CPT 99406/99407.

Annual Wellness Visit (AWV) Tobacco Screening

The Annual Wellness Visit, established under Section 1861(hhh) of the Social Security Act effective January 1, 2011, provides an annual preventive visit focused on health risk assessment, personalized prevention plan service, and coordination of preventive services. The AWV includes tobacco use screening as part of the comprehensive health risk assessment. Tobacco use identified during the AWV can be similarly coordinated into structured cessation attempts.

The AWV and IPPE pathways function as natural entry points into the tobacco cessation counseling benefit for Georgia Medicare beneficiaries who may not have raised tobacco use with their primary care provider in other clinical encounters. Beneficiaries should ensure their AWV or IPPE includes documented tobacco use screening, and should not hesitate to request a cessation referral if they are interested in quitting.

Coordination With Lung Cancer Screening Under NCD 210.14

The Medicare lung cancer screening benefit under NCD 210.14 provides annual low-dose computed tomography (LDCT) screening for current and former tobacco users meeting eligibility criteria. The LDCT benefit was originally established effective February 5, 2015 under NCD 210.14 and was substantially expanded effective February 10, 2022 to align with the USPSTF 2021 Grade B recommendation. Current LDCT eligibility under NCD 210.14:

• Age 50 to 77 years
• 20+ pack-year smoking history (a pack-year is one pack per day for one year; 20 pack-years is one pack per day for 20 years, or two packs per day for 10 years, etc.)
• Current smoker, or former smoker who quit within the prior 15 years
• Asymptomatic (no signs or symptoms of lung cancer)
• Receives written order from physician or other qualified practitioner

The coordination between tobacco cessation counseling and lung cancer screening is bidirectional. Tobacco-using beneficiaries identified through cessation counseling may meet LDCT eligibility criteria and should be referred for lung cancer screening. Conversely, current tobacco users undergoing annual LDCT screening should be referred for tobacco cessation counseling, as the LDCT screening visit is required to include a tobacco cessation counseling component for current smokers.

The Georgia Tobacco Cessation Landscape

Georgia Tobacco Use Burden

Georgia tobacco use prevalence has historically tracked above national averages, with substantial variation by county, race, ethnicity, education level, and rurality. Adult cigarette smoking prevalence in Georgia is elevated relative to national averages, with particular concentrations in rural counties and among lower-income populations. African American populations in Georgia have historically experienced disparate tobacco-related morbidity, particularly lung cancer and cardiovascular mortality, despite roughly comparable smoking prevalence to other racial and ethnic groups in some surveys. Smokeless tobacco use is elevated in certain rural Georgia populations relative to national averages.

The tobacco-related mortality burden in Georgia includes lung cancer, COPD, cardiovascular disease (including myocardial infarction and stroke), and other malignancies for which tobacco use is a documented risk factor. Tobacco-related healthcare costs in Georgia run into billions of dollars annually across Medicare, Medicaid, and private insurance.

Georgia Tobacco Quit Line (1-877-270-7867)

The Georgia Tobacco Quit Line provides free telephone-based tobacco cessation counseling to all Georgia residents regardless of insurance status. Services include:

• Telephone counseling sessions with trained tobacco cessation specialists
• Web-based cessation programs
• Text message support
• Nicotine replacement therapy starter kits (typically 2 weeks of NRT) for eligible callers
• Coordination with Medicare CPT 99406/99407 counseling for beneficiaries whose primary care provider integrates quitline referral into a cessation attempt

The quitline operates as a complementary service to the Medicare tobacco cessation counseling benefit. Beneficiaries can use the quitline alongside their Medicare-covered counseling sessions, with the quitline providing additional contact points between scheduled counseling sessions.

Georgia DPH Tobacco Use Prevention Program

The Georgia Department of Public Health Tobacco Use Prevention Program coordinates state-level tobacco control activities including surveillance, policy advocacy, cessation services support, youth prevention, secondhand smoke exposure reduction, and disparities reduction. The program coordinates with CDC funding (Office on Smoking and Health) and supports the Georgia Tobacco Quit Line operations.

American Lung Association Georgia

The American Lung Association Georgia chapter provides Freedom From Smoking group cessation programs (in-person and online) for Georgia residents. The Freedom From Smoking program is a structured eight-session course covering preparation for quitting, the quit day, managing withdrawal, preventing relapse, and maintaining cessation. The program complements Medicare CPT 99406/99407 counseling and can be used alongside Medicare-covered services.

Emory Tobacco Cessation Program

The Emory University School of Medicine and Emory Healthcare offer dedicated tobacco cessation services through the Emory Tobacco Cessation Program. The program provides intensive counseling integrated with pharmacotherapy management for Emory patients including Medicare beneficiaries. Similar programs operate at other major Georgia academic medical centers.

FQHC Network and Rural Access

Georgia's federally qualified health center network — including Mercy Care, Whitefoord, West End Medical, Albany Area Primary Health, Curtis V. Cooper Primary Health, Diversity Health Center, Four Corners Primary Care, and many others — provides primary care including tobacco cessation counseling to underserved populations on a sliding-fee basis. For Medicare beneficiaries, the tobacco cessation counseling benefit operates at FQHCs under the same CPT 99406/99407 framework with zero cost-sharing under ACA Section 4104.

Rural Georgia tobacco cessation access can be challenging due to provider workforce shortages in some counties. The Georgia Tobacco Quit Line provides a critical access point for rural beneficiaries who may not have nearby in-person cessation services.

Best Practices for Georgia Medicare Tobacco Cessation Counseling

1. Use the AWV or IPPE as the entry point. Beneficiaries enrolling in Medicare should request that their IPPE include thorough tobacco use screening within the first twelve months of enrollment. Beneficiaries with continuing Medicare coverage should ensure tobacco screening occurs at the Annual Wellness Visit.

2. Discuss both behavioral counseling and pharmacotherapy at the first session. Combined behavioral counseling plus pharmacotherapy produces substantially higher cessation rates than either intervention alone. The first counseling session should include pharmacotherapy planning even if pharmacotherapy initiation is scheduled for a subsequent visit.

3. Use combination NRT for moderate-to-heavy smokers. Combination NRT — patch plus gum/lozenge/inhaler — is supported by clinical evidence as more effective than single-formulation NRT for smokers consuming a pack or more per day.

4. Set a specific quit date. Cessation attempts succeed more often when the quit date is specific and proximate rather than vague and indefinite. The quit date is typically set 1-2 weeks after the first counseling session to allow medication initiation.

5. Schedule follow-up sessions across the quit attempt timeline. Standard scheduling distributes the four sessions per cessation attempt across the initial visit, one week after quit date, four weeks after quit date, and three months after quit date. This timeline aligns with the highest-relapse-risk windows.

6. Use motivational interviewing for beneficiaries not yet ready to quit. The 5 R's framework (Relevance, Risks, Rewards, Roadblocks, Repetition) provides a structured approach for tobacco users who are not yet ready for a cessation attempt. CPT 99407 documentation can support motivational interviewing visits.

7. Coordinate with Georgia Tobacco Quit Line. Beneficiaries can use the Georgia Tobacco Quit Line at 1-877-270-7867 alongside Medicare-covered counseling sessions. The quitline provides additional contact points and NRT starter kits.

8. Use the second cessation attempt if the first fails. Tobacco cessation rarely succeeds on the first attempt. Beneficiaries should not interpret a failed first attempt as a permanent outcome — the second cessation attempt within the same twelve-month period provides four additional sessions to support another quit attempt.

9. Screen for lung cancer screening eligibility. Tobacco-using beneficiaries age 50-77 with 20+ pack-year history and current smoker or quit within 15 years are eligible for annual LDCT lung cancer screening under NCD 210.14.

10. Document carefully for CPT 99406 vs CPT 99407. Documentation must support time spent (3-10 minutes for 99406, greater than 10 minutes for 99407) and content delivered. Inadequate documentation can result in claim denials.

11. Address dual tobacco use. Beneficiaries using both combustible cigarettes and other tobacco products (cigars, pipe, smokeless tobacco, electronic cigarettes) should have all products addressed in the cessation attempt. The USPSTF 2021 update concluded evidence is insufficient (I statement) to recommend electronic cigarettes for cessation.

12. Address smokeless tobacco use specifically. Smokeless tobacco users in Georgia, particularly in rural counties, benefit from cessation counseling adapted to smokeless tobacco patterns. Behavioral counseling addresses oral fixation, social context, and craving patterns specific to smokeless use.

13. Consider mental health and substance use comorbidities. Beneficiaries with depression, anxiety, alcohol use disorder, or other substance use disorder have higher tobacco use prevalence and lower cessation success rates. Integrated treatment addressing comorbidities improves cessation outcomes.

14. Review pharmacotherapy contraindications and interactions. Bupropion contraindications include seizure disorder, eating disorders, and concurrent MAOI use. Varenicline cautions include psychiatric history (revised 2016 with FDA removal of black box warning, though clinical monitoring remains appropriate). NRT cautions include recent cardiovascular events and pregnancy considerations.

Common Issues and How to Resolve Them

1. Cessation counseling visits denied for inadequate documentation. Resolution: Ensure clinical documentation supports time spent in counseling (3-10 minutes for 99406, >10 minutes for 99407) and content delivered (5 A's elements for 99406, comprehensive content for 99407). Time documentation should be specific (e.g., "5 minutes face-to-face tobacco cessation counseling using 5 A's framework").

2. Beneficiary unaware that cessation counseling is covered at zero cost. Resolution: Educate beneficiaries that ACA Section 4104 waives cost-sharing for tobacco cessation counseling under CPT 99406/99407. Beneficiaries should owe nothing out of pocket for these services.

3. Beneficiary unaware of eight-session-per-twelve-month framework. Resolution: Explain the framework: two cessation attempts per twelve-month period, four sessions per attempt, eight sessions total. Beneficiaries can pursue a second cessation attempt if the first does not succeed.

4. Pharmacotherapy cost barriers. Resolution: Review Part D formulary options. Generic NRT, generic bupropion SR, and generic varenicline are typically the most affordable options. Beneficiaries facing affordability challenges should contact GeorgiaCares SHIP at 1-866-552-4464 for Part D plan comparison.

5. Beneficiary in rural Georgia county with limited in-person cessation services. Resolution: Use the Georgia Tobacco Quit Line at 1-877-270-7867 for telephone counseling. Telehealth Medicare CPT 99406/99407 may also be available depending on the provider and current telehealth policy.

6. Beneficiary not yet ready to quit. Resolution: Use motivational interviewing under the 5 R's framework (Relevance, Risks, Rewards, Roadblocks, Repetition). CPT 99407 intensive counseling can support motivational interviewing visits. Repeat the intervention at each subsequent clinical encounter.

7. Beneficiary relapsed after initial successful quit. Resolution: Relapse is common in tobacco cessation. Reframe relapse as a normal part of the quit process and offer to begin a second cessation attempt within the same twelve-month period. Use lessons from the first attempt (specific triggers, withdrawal patterns, situations) to inform the second attempt.

8. Beneficiary with depression or anxiety. Resolution: Integrate tobacco cessation with mental health treatment. Bupropion SR may be useful given its antidepressant properties at higher doses. Coordinate with the Medicare depression screening benefit under NCD 210.9 if depression has not been diagnosed.

9. Beneficiary with alcohol use disorder. Resolution: Integrate tobacco cessation with alcohol misuse screening and counseling under NCD 210.8. Concurrent treatment of both substance use disorders generally produces better outcomes than sequential treatment.

10. Beneficiary using electronic cigarettes for cessation. Resolution: Explain the USPSTF 2021 conclusion that evidence is insufficient (I statement) for electronic cigarettes as cessation aids. Offer FDA-approved pharmacotherapy as the evidence-based alternative.

11. Beneficiary using smokeless tobacco. Resolution: Adapt counseling to smokeless tobacco use patterns. Oral fixation, social context (chewing tobacco use in agricultural and outdoor work settings), and specific craving patterns differ from combustible tobacco. NRT can be effective for smokeless tobacco cessation.

12. Lung cancer screening eligibility not addressed. Resolution: Screen tobacco-using beneficiaries for LDCT lung cancer screening eligibility (age 50-77, 20+ pack-years, current smoker or quit within 15 years). Refer eligible beneficiaries for annual LDCT under NCD 210.14.

13. Beneficiary concerned about varenicline psychiatric effects. Resolution: Discuss the 2016 FDA removal of the black box warning following the EAGLES trial that found no significant increase in psychiatric adverse events. Clinical monitoring for mood changes remains appropriate but varenicline is broadly recognized as safe and effective.

14. Beneficiary continues to smoke despite multiple cessation attempts. Resolution: Continue offering cessation support — repeated attempts are normal and ultimately successful for most quitters. Consider intensifying the regimen (combination NRT, varenicline plus NRT under specialist guidance, intensive behavioral counseling). Refer to Emory Tobacco Cessation Program or another specialty cessation program if available.

Worked Examples

Example 1: Fulton County 68-Year-Old 30-Pack-Year Smoker — AWV Identifies Use Plus Four-Session Intensive Counseling Plus Varenicline

A 68-year-old Fulton County Medicare beneficiary attends her Annual Wellness Visit at an Atlanta primary care practice. Her health risk assessment documents 30-pack-year smoking history (one pack per day for 30 years) and current daily smoking. Her primary care physician asks whether she is interested in quitting; she says yes.

The AWV concludes with a tobacco cessation referral. The beneficiary returns the following week for an initial intensive tobacco cessation counseling session (CPT 99407, 25 minutes) covering: detailed smoking history (quantity, duration, prior quit attempts), nicotine dependence assessment using Fagerström Test for Nicotine Dependence (score 7, indicating high dependence), pharmacotherapy planning, behavioral skills training, and quit date setting. The physician prescribes varenicline 0.5 mg daily titrated upward over the first week to 1 mg twice daily, with quit date set 1 week after starting medication. The Part D plan covers generic varenicline with a modest copay.

The beneficiary's cessation attempt proceeds with four counseling sessions across the first three months under CPT 99406/99407 (initial 99407, one-week follow-up 99406, four-week follow-up 99407, three-month follow-up 99406). She maintains abstinence at three months with continued varenicline for twelve weeks total. The primary care physician refers her for LDCT lung cancer screening under NCD 210.14 given her age (68), pack-year history (30), and recent former smoker status (quit within prior 15 years). All counseling visits are zero cost-sharing under ACA Section 4104.

Example 2: Worth County 72-Year-Old Rural Smoker — Quitline Integration Plus NRT Patches

A 72-year-old Worth County Medicare beneficiary in rural southwest Georgia attends his primary care visit at a local FQHC. He has smoked for 50 years and has been thinking about quitting since his neighbor was diagnosed with lung cancer six months ago. He has not seen a tobacco cessation specialist before.

The FQHC primary care physician provides intermediate tobacco cessation counseling (CPT 99406, 8 minutes) covering brief 5 A's framework: ask about tobacco use, advise quitting, assess readiness (the beneficiary is contemplative but not yet ready to set a quit date), assist with information about cessation pharmacotherapy and the Georgia Tobacco Quit Line at 1-877-270-7867, arrange follow-up in two weeks.

The beneficiary calls the Georgia Tobacco Quit Line and receives telephone counseling sessions plus a two-week NRT patch starter kit. He sets a quit date two weeks out. He returns to the FQHC for follow-up (CPT 99406, 7 minutes) confirming his quit date, reviewing patch use (21 mg/24 hours), and discussing common challenges. His Part D plan covers extended NRT patches with a modest copay.

The beneficiary maintains abstinence at one-month follow-up (CPT 99406) and three-month follow-up (CPT 99406). He completes four sessions across the cessation attempt. All counseling visits at the FQHC are zero cost-sharing under ACA Section 4104.

Example 3: DeKalb County 67-Year-Old Second Cessation Attempt After Relapse Plus Bupropion SR

A 67-year-old DeKalb County Medicare beneficiary completed a first cessation attempt earlier this year with varenicline plus four counseling sessions, achieving three months of abstinence before relapsing during a period of family stress. She returns to her primary care physician at month seven of the twelve-month period asking to try again.

Her primary care physician confirms eligibility for a second cessation attempt within the same twelve-month period (four additional sessions available). The initial second-attempt visit is intensive (CPT 99407, 20 minutes) covering: review of the first attempt (what worked, what triggered the relapse), discussion of medication options for the second attempt, and selection of bupropion SR (the beneficiary did not tolerate varenicline well during the first attempt due to vivid dreams).

The beneficiary begins bupropion 150 mg daily for 3 days, then 150 mg twice daily, with quit date set 1 week after medication initiation. She receives three additional follow-up counseling sessions (CPT 99406 at one week, CPT 99406 at four weeks, CPT 99407 at three months including detailed relapse prevention planning). She maintains abstinence at three months. Part D covers generic bupropion SR with a modest copay. All counseling visits are zero cost-sharing.

Example 4: Cobb County 65-Year-Old Newly Medicare-Eligible — IPPE Entry Plus 99406 Intermediate Counseling

A 65-year-old Cobb County beneficiary becomes Medicare-eligible and schedules his Initial Preventive Physical Examination within the first six months of enrollment. His IPPE health risk assessment documents 25-pack-year smoking history (one pack per day for 25 years), current half-pack-per-day smoking, and tobacco-related comorbidities (mild COPD, controlled hypertension).

His primary care physician completes the IPPE including tobacco use screening as a required component. The IPPE counseling component flows into a structured tobacco cessation counseling visit (CPT 99406, 9 minutes) covering 5 A's framework: ask, advise (clear strong personalized advice given his COPD), assess (the beneficiary is willing to quit), assist (pharmacotherapy planning, quitline referral, quit date setting two weeks out), arrange (follow-up scheduled).

The beneficiary begins nicotine patches (21 mg/24 hours) two weeks before quit date for behavioral adjustment. His primary care physician schedules four counseling sessions across the cessation attempt under CPT 99406/99407. The physician also refers him for LDCT lung cancer screening under NCD 210.14 given his age (65), pack-year history (25), and current smoker status. All counseling visits are zero cost-sharing.

Example 5: Bibb County 70-Year-Old COPD Plus Cessation Plus LDCT Lung Cancer Screening Coordination

A 70-year-old Bibb County Medicare beneficiary with diagnosed COPD attends his primary care visit. He has smoked for 55 years (currently 1.5 packs per day, approximately 80 pack-year history), uses albuterol and tiotropium for COPD, and is hospitalized once every 18 months for COPD exacerbation. His pulmonologist has repeatedly recommended cessation; he has not previously engaged in a structured cessation attempt.

The primary care physician provides intensive tobacco cessation counseling (CPT 99407, 22 minutes) covering: detailed smoking history, nicotine dependence (Fagerström score 8), COPD-specific cessation messaging (cessation slows COPD progression and reduces exacerbation frequency), pharmacotherapy selection (combination therapy — varenicline plus nicotine patches under specialist guidance, given high dependence), and quit date.

The beneficiary's cessation attempt includes four counseling sessions under CPT 99406/99407 plus coordination with pulmonology. He is referred for annual LDCT lung cancer screening under NCD 210.14 given his age (70), pack-year history (80), and current smoker status. He is also evaluated for Medicare pulmonary rehabilitation coverage given his COPD diagnosis. Part D covers varenicline and NRT patches. All cessation counseling is zero cost-sharing.

Example 6: Hall County 75-Year-Old Chewing Tobacco User Plus 99407 Intensive Counseling Plus Combination NRT

A 75-year-old Hall County Medicare beneficiary uses smokeless tobacco (snuff/chewing tobacco) — never smoked combustible cigarettes — for 50 years. His dentist recently identified an oral mucosal lesion requiring biopsy, motivating him to consider cessation. He attends his primary care visit.

The primary care physician provides intensive tobacco cessation counseling (CPT 99407, 18 minutes) covering: smokeless tobacco-specific cessation messaging (oral cancer risk, periodontal disease, cardiovascular risk), nicotine dependence assessment, behavioral pattern analysis (oral fixation, situations triggering use, social context), pharmacotherapy planning, and quit date.

The beneficiary begins combination NRT — nicotine patches (21 mg/24 hours) for baseline replacement plus nicotine lozenges (4 mg) for breakthrough cravings replacing the oral sensation of smokeless tobacco use. His Part D plan covers both NRT formulations with modest copays.

The beneficiary's cessation attempt includes four counseling sessions across three months under CPT 99406/99407 (initial 99407, two-week follow-up 99406, six-week follow-up 99406, three-month follow-up 99407). His oral mucosal lesion biopsy returns benign hyperplasia. He maintains abstinence at three months. All cessation counseling is zero cost-sharing.

Frequently Asked Questions

Georgia Medicare Tobacco Cessation Contacts

• Medicare: 1-800-MEDICARE (1-800-633-4227) — general Medicare information and coverage questions
• Palmetto GBA MAC: 1-866-238-9650 — Georgia Medicare Administrative Contractor for Part A and Part B claims
• DCH Medicaid Member Services: 1-866-211-0950 — Georgia Medicaid member services including dual-eligible cessation coverage
• GeorgiaCares SHIP: 1-866-552-4464 — free Medicare counseling including Part D plan comparison
• Medicare Rights Center: 1-800-333-4114 — free national Medicare counseling and appeals support
• Atlanta Legal Aid: 404-377-0701 — legal services for Atlanta-area Medicare beneficiaries
• GA Legal Services: 1-800-498-9469 — legal services for Georgia outside Atlanta
• 211 Georgia: dial 211 — community resource referral including health and social services
• Eldercare Locator: 1-800-677-1116 — national Administration on Aging service connecting seniors with local services
• Georgia DPH: 404-657-2700 — Georgia Department of Public Health main line
• Georgia Tobacco Quit Line: 1-877-270-7867 (English) / 1-877-2NO-FUMO (Spanish)
• National Quitline: 1-800-QUIT-NOW (1-800-784-8669) — federal portal to state quitlines
• CDC-INFO: 1-800-232-4636 — federal tobacco control information
• American Lung Association Georgia — Freedom From Smoking cessation programs
• Emory Tobacco Cessation Program — Emory Healthcare specialty cessation services
• Acentra Health QIO: 1-844-455-8708 — Georgia Quality Improvement Organization
• Medicare.gov: medicare.gov — federal Medicare website including preventive services details
• Smokefree.gov: smokefree.gov — federal cessation resource portal