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Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Last updated: May 16, 2019

CMS Measure ID: CMS138v5
Version: 5
NQF Number: 0028
Measure Description:

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user

Initial Population:

All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:


Numerator Statement:

Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason)

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Community/Population Health
Next Version:
Previous Version:
Measure Scoring: Proportion
Measure Type: Process
Improvement Notation:

Higher score indicates better quality


If a patient uses any type of tobacco (ie, smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.

If tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numeratorinfo-icon and should be considered a measure failure. Instances where tobacco use status of unknown is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominatorinfo-icon of the measure and reported as a valid exception.

The medical reason exception only applies to the screening data element of the measure; once a patient has been screened, there are no allowable medical reason exceptions for not providing the intervention.

If a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exceptioninfo-icon for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.

As noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.

Quality ID: 226
High Priority Measure: No
Data Submission Method: Claims,CMS Web Interface,EHR,Registry
Specialty Measure Set: Allergy/Immunology,Internal Medicine,Cardiology,Dermatology,Emergency Medicine,Gastroenterology,General Surgery,General Oncology,Hospitalists,Neurology,Obstetrics/Gynecology,Ophthalmology,Orthopedic Surgery,Otolaryngology,Physical Medicine,Preventive Medicine,Rheumatology,Thoracic Surgery,Urology,Vascular Surgery,Mental/Behavioral Health,Plastic Surgery,General Practice/Family Medicine


Release Notes


  • Updated Clinical Recommendation Statements.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Updated Disclaimer.

    Section: Disclaimer

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Added Guidance regarding the omission of electronic nicotine delivery systems (ENDS) from this measure due to insufficient evidence.

    Section: Guidance

    Source: JIRA (CQMinfo-icon-1889)

  • Updated Guidance related to denominator exceptioninfo-icon applicability; clarified the medical reason exception is unchanged, but the limited life expectancy applicability has been updated.

    Section: Guidance

    Source: JIRA (CQM-1335)

  • Updated Measure Developerinfo-icon.

    Section: Measure Developer

    Source: Measure Lead

  • Updated Measure Stewardinfo-icon.

    Section: Measure Steward

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead


  • Expanded the applicability of the 'Limited Life Expectancy' denominator exception to apply to either of the numeratorinfo-icon quality actions (screening or cessation intervention). If a patient has a diagnosis of 'Limited Life Expectancy', it is an allowable exception.

    Section: Denominator Exceptionsinfo-icon

    Source: JIRA (CQM-1335)

  • Added 'Home Healthcare Services' as applicable encounters.

    Section: Initial Populationinfo-icon

    Source: JIRA (CQM-1708)

  • Updated ‘Limited Life Expectancy’ to reflect a QDM datatypeinfo-icon of ‘Diagnosis’.

    Section: QDM Data Elements

    Source: JIRA (CQM-1335)

Value Setinfo-icon

  • Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): added to measure including 9 CPT codes (99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350).

    Section: None

    Source: JIRA (CQM-1708)

  • Value set Medical Reason (2.16.840.1.113883.3.526.3.1007): Deleted 1 SNOMEDCT code (161590003).

    Section: None

    Source: None

  • Value set Tobacco Use Cessation Pharmacotherapy (2.16.840.1.113883.3.526.3.1190): Added 3 RXNORM codes (1232585, 1551468, 966531) and deleted 5 RXNORM codes (1046847, 1046858, 311972, 311973, 419168).

    Section: None

    Source: None

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