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CMS 138v10: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Updated June 8, 2026 6 minute read

Measure: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user. Three rates are reported:

  1. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period
  2. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention
  3. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user
Measure TypeHigh Priority MeasureScoring
ProcessNoA higher percentage indicates better quality
Denominator

Denominator 1: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Denominator 2: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period who were screened for tobacco use and identified as a tobacco user

Denominator 3: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Numerator

Numerator 1: Patients who were screened for tobacco use at least once during the measurement period

Numerator 2: Patients who received tobacco cessation intervention

Numerator 3: Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Denominator Exceptions

Denominator 1 Exceptions: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)

Denominator 2 Exceptions: Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason)

Denominator 3 Exceptions: Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)

Denominator ExclusionsNone
Denominator
Denominator 1

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC
Encounter Codes Eligible for Denominator 1

CPT: 96156, 96158, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

Preventive Care Encounter Codes Eligible for Denominator 1

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Denominator 2

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC

    AND

  • Were screened for tobacco use and identified as a tobacco user
Encounter Codes Eligible for Denominator 2

CPT: 96156, 96158, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

Preventive Care Encounter Codes Eligible for Denominator 2

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Screening and Identification as a Tobacco User

Screening for tobacco use is documented in the Past History tab of the patient encounter.

  1. Go to Encounter > Past History > Structured > Social History
  2. Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
  3. Select the appropriate patient status from the Smoking Status list or select Y or N for Smokeless Tobacco Use
    1. If populating the Smoking status field, click OK to save
  • Selecting Current every day smoker, Current some day smoker, Heavy tobacco smoker, or Light tobacco smoker from Smoking Status identifies a patient as a tobacco user
  • Selecting Y for Smokeless Tobacco Use identifies a patient as a tobacco user
Denominator 3

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC
Encounter Codes Eligible for Denominator 3

CPT: 96156, 96158, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

Preventive Care Encounter Codes Eligible for Denominator 3

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Denominator Exceptions
Denominator 1 Exception

A patient will be counted as an exception for Denominator 1 if there is documentation of a medical reason for not screening for tobacco use.

To document this exception:

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Tobacco Cessation Intervention flowsheet and click Add
  4. Click Add Column
  5. Select a Value from the Tobacco use screening not done due to list
  6. Click OK to save
Denominator 2 Exception

A patient will be counted as an exception for Denominator 2 if there is documentation for not providing tobacco cessation intervention.

To document this exception:

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Tobacco Cessation Intervention flowsheet and click Add
  4. Click Add Column
  5. Select a Value from the Patient identified as tobacco user, intervention not done due to list
  6. Click OK to save
Denominator 3 Exception

A patient will be counted as an exception for Denominator 3 if there is documentation for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users.

Exceptions for Denominator 3 can be performed using the steps outlined in Denominator Exception 1 and Denominator Exception 2.

Numerator
Numerator 1

A patient will be counted in Numerator 1 if they were screened for tobacco use at least once during the Measurement Period. If a patient received multiple screenings, the most recent screening will be counted toward the numerator.

Tobacco Use Screening
  1. Go to Encounter > Past History > Structured > Social History
  2. Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
  3. Select the appropriate patient status from the Smoking Status list or select Y or N for Smokeless Tobacco Use
    1. If populating the Smoking status field, click OK to save
Note

Selecting a Smoking Status of Unknown if ever smoked is equivalent to not performing a screening, and patients with this status will not be counted in the numerator

Tip

If a tobacco use screening was already documented during a previous visit, and there have been no changes to the patient’s tobacco use status, selecting the Social History checkbox from Areas Reviewed in Past History will continue to count the patient toward the numerator on subsequent eligible encounters.

Numerator 2

A patient will be counted in Numerator 2 if they received tobacco cessation intervention during the Measurement Period.

Tobacco Cessation Interventions
Document an Intervention from the Tobacco Cessation Intervention Flowsheet
  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Tobacco Cessation Intervention flowsheet and click Add
  4. Click Add Column
  5. Select Done for Tobacco use cessation education or Referral for cessation counseling
  6. Click OK to save
Tobacco Cessation Counseling

To document tobacco cessation counseling as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99406, 99407

Order Status must be marked as Complete.

Medication

To prescribe a medication for pharmacological therapy, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible tobacco use cessation medications can be located here.

Numerator 3

A patient will be counted in Numerator 3 if they were screened for tobacco use at least once during the Measurement Period AND if they received tobacco cessation intervention during the Measurement Period if identified as a tobacco user.

Numerator 3 can be met by completing the Tobacco Use Screening outlined in Numerator 1 and documenting one of theTobacco Cessation Interventions outlined in Numerator 2.

eCQI Reference

https://ecqi.healthit.gov/ecqm/ep/2022/cms138v10

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