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 Go to Encounter > Past History > Structured > Social HistorySelect the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use nodeSelect the appropriate patient status from the Smoking Status list or select Y or N for Smokeless Tobacco UseIf 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 or in the six months prior to the Measurement Period. Tobacco Cessation Interventions Document an Intervention from the Tobacco Cessation Intervention Flowsheet Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > StandardClick Add New FlowsheetSelect the Tobacco Cessation Intervention flowsheet and click AddClick Add ColumnSelect Done for Tobacco use cessation education or Referral for cessation counselingClick 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. To document tobacco cessation counseling as a diagnosis, go to Encounter > Assessment and add the following code: ICD-10: Z71.6 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 or in the six months prior to 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.

CMS 138v11: 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 during the measurement period or in the six months prior to the measurement periodif identified as a tobacco user. Three rates are reported:

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period
Percentage of patients aged 18 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period
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 during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

Measure Type

High Priority Measure

Scoring

Process

A 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 during the measurement period 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 during the measurement period or in the six months prior to the measurement period Numerator 3: Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user
Denominator Exceptions	None
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period

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, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

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

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, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

Screening and Identification as a Tobacco User

Screening for tobacco use is documented in the Past History tab of the patient encounter. The patient must be screened during the Measurement Period.

Go to Encounter > Past History > Structured > Social History
Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
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

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, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

Denominator Exclusions

Patients who were in hospice care during any part of the Measurement Period will be excluded from the measure.

To document hospice care ambulatory services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

To document hospice care encounter services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9996, G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

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

Go to Encounter > Past History > Structured > Social History
Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
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 or in the six months prior to the Measurement Period.

Tobacco Cessation Interventions

Document an Intervention from the Tobacco Cessation Intervention Flowsheet

Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard
Click Add New Flowsheet
Select the Tobacco Cessation Intervention flowsheet and click Add
Click Add Column
Select Done for Tobacco use cessation education or Referral for cessation counseling
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.

To document tobacco cessation counseling as a diagnosis, go to Encounter > Assessment and add the following code:

ICD-10: Z71.6

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 or in the six months prior to 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/ec/2023/cms138v11

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