Skip to Main Content

Johns Hopkins Health Plans

TSC-E Tobacco Use Screening and Cessation Intervention

Product Lines: Advantage MD, EHP, Priority Partners and USFHP.

Measurement Period: January 1–December 31.

Description:
The percentage of persons 12 years of age and older who were screened for commercial tobacco product use at least once during the measurement period, and who received tobacco cessation intervention if identified as a tobacco user. Two rates are reported:

  1. Tobacco Use Screening. The percentage of persons who were screened for tobacco use. Cessation Intervention.
  2. The percentage of persons who were identified as a tobacco user and who received tobacco cessation intervention.

Stratifications:

Age as of the start of the measurement period.

  • 12–17 years (commercial and Medicaid only).
  • 18–64 years.
  • 65 years and Older.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • ECDS.

Initial Population:

  • Measure Item Count: Person.
  • Age: 12 years of age and older at the start of the measurement period.
  • Benefits: Medical.
  • Continuous Enrollment: 180 days prior to the measurement period through the last day of the measurement period.
  • Allowable gap: No more than one gap of ≤45 days during the continuous enrollment period. No gaps on the last day of the measurement period.

Definition:
Positive tobacco user: Persons who were screened for tobacco use and had a documented positive result. Any of the following meet criteria:

  • Tobacco Use Screening Value Set with Yes Value Set.
  • LOINC code 72166-2 with Positive Tobacco Use Status Value Set.

Negative tobacco user: Persons who were screened for tobacco use and had a documented negative result. Any of the following meet criteria:

  • Tobacco Use Screening Value Set with No Value Set.
  • LOINC code 72166-2 with Negative Tobacco Use Status Value Set.

Denominator:

Denominator 1: The initial population minus denominator exclusions.
Denominator 2: Persons from numerator 1 who were identified as a positive tobacco user between January 1 and December 1 of the measurement period.

Numerator:

Numerator 1: Tobacco use screening.
Persons who were screened for tobacco use and identified as either a positive or negative tobacco user (see Definitions above) during the measurement period.

Numerator 2: Cessation intervention.
Persons who received tobacco cessation intervention during the measurement period or 180 days prior to the measurement period. The following meet criteria:

Persons 12–17 years of age who received tobacco cessation counseling during the measurement period or in the 180 days prior to the measurement period.

Persons 18 years of age and older who received tobacco cessation counseling or dispensed pharmacotherapy intervention during the measurement period or 180 days prior to the measurement period.


Best Practice and Measure Tips

  • New Measure for HEDIS MY 2026.
  • Standardized Screening Protocols:
    • Screen all patients aged 12 and older at least once annually.
    • Integrate screening into routine visits (e.g., annual physicals, new patient visits, chronic care follow-ups).
    • Use EHR prompts to ensure screening is not missed.
  • Use Team-Based Workflow:
    • Train medical assistants and nurses to ask about tobacco use during intake.
    • Document responses in the History or Vitals section of the EHR.
    • Flag tobacco users for provider follow-up.
  • Provide Tailored Interventions:
    • For patients ready to quit:
      • Offer FDA-approved nicotine replacement therapy (NRT).
      • EHP: Prescription and OTC tobacco cessation products (including Chantix) are covered, limited to FDA approved dosages. A prescription from a physician is required for coverage of OTC products. No copay applies to most prescribed tobacco cessation medications. Prescribe generic versus brand.
      • Priority Partners: Tobacco cessation medication is covered by Maryland Department of Health (MDH) Medicaid Pharmacy Program for Substance Use Disorder (SUD) Medication.
      • USFHP: Members can order medications and nicotine replace therapies through the home delivery program and Walgreens retail outlets at no cost with a prescription.
      • Refer to smoking cessation clinics or Quitlines.
      • Maryland Department of Health Center for Tobacco Prevention and Control - Maryland Tobacco Quitline
    • For patients not ready to quit:
      • Provide educational handouts.
      • Encourage future engagement with cessation resources.
  • Document Thoroughly:
    • Ensure both screening and intervention are clearly documented.
    • Use appropriate CPT codes and quality data codes for claims and registry reporting.
  • Leverage Clinical Decision Support Tools:
    • Use Million Hearts® protocols and CDC cessation guides to standardize care.
    • Implement EHR templates that prompt clinicians to:
      • Ask about tobacco use.
      • Advise quitting.
      • Offer cessation support.
  • Track and Analyze Performance:
    • Use run charts to monitor screening and intervention rates over time.
    • Include outcome, process, and balancing measures in your QI strategy. [medicaid.gov]
  • Engage Patients:
    • Use motivational interviewing techniques.
    • Provide culturally appropriate materials and support.
  • Address Barriers:
    • Identify patients with exceptions (e.g., terminal illness, adverse reactions to pharmacotherapy) and document appropriately.
  • Continuous Education:
    • Train staff regularly on tobacco cessation guidelines and documentation requirements.
    • Stay updated with USPSTF recommendations and evidence-based practices.

Resources:

Measure Exclusions

Denominator Exclusions:

  • Persons in hospice or using hospice services any time during the measurement year.
  • Persons who died any time during the measurement period
  • Persons receiving palliative care or who had an encounter for palliative care any time during the measurement period.*

Numerator Exclusions:

  • Laboratory claims (POS 81)

Measure Codes

Tobacco Use Screening

  • ICD-10-CM: Z71.6
  • LOINC codes screening with Yes and No values:
    • 39240-7- Tobacco use status CPHS
    • 68535-4- Have you used tobacco in the last 30 days [SAMHSA]
    • 68536-2- Have you used smokeless tobacco product in the last 30 days [SAMHSA]
    • Yes values:
      • LOINC: LA33-6
      • SNOMED CT US Edition: 373066001
    • No values:
      • LOINC: LA32-8
      • SNOMED CT US Edition: 373067005
  • LOINC code 72166-2 Tobacco smoking status with Negative or Positive use status
    • Negative Tobacco Use Status
      • LOINC: LA15920-4- Former smoker
      • LOINC: LA18978-9- Never smoker
      • SNOMED CT US Edition: 8392000, 8517006, 53896009, 87739003, 105539002, 105540000, 105541001, 160620009, 160621008, 228491005, 228492003, 228493008, 228501004, 228502006, 228503001, 228511006, 228512004, 228513009, 266919005, 266921000, 266922007, 266923002, 266924008, 266925009, 266928006, 281018007, 360890004, 360900008, 360918006, 360929005, 405746006, 702975009, 702979003, 735128000, 1137688001, 1137690000, 1137692008, 221000119102, 48031000119106, 428081000124100, 428091000124102, 451371000124109, 451381000124107, 456711000124105, 881671000124101, 881681000124103
    • Positive Tobacco Use Status
      • LOINCLA18976-3- Current every day smoker
      • LA18977-1- Current some day smoker
      • LA18981-3- Heavy tobacco smoker
      • LA18982-1- Light tobacco smoker
      • SNOMED CT US Edition: 56578002, 56771006, 59978006, 65568007, 77176002, 81703003, 82302008, 110483000, 160603005, 160604004, 160605003, 160606002, 160619003, 228494002, 228499007, 228504007, 228514003, 228515002, 228516001, 228517005, 228518000, 230059006, 230060001, 230062009, 230063004, 230064005, 230065006, 266920004, 449867007, 449868002, 449869005, 698289004, 713914004, 722499006, 785889008, 1137691001, 35341000087101, 35371000087109, 428041000124106, 428061000124105, 428071000124103, 450811000124104, 450821000124107, 881661000124108, 881721000124105, 881731000124108

Tobacco Use Cessation Counseling

  • CPT: 99406, 99407
  • SNOMED CT US Edition: 171055003, 185795007, 185796008, 225323000, 225324006, 310429001, 315232003, 384742004, 395700008, 702388001, 710081004, 711028002, 713700008, 1148687006, 449841000124108, 449851000124105, 449861000124107

Measure Medication

  • Tobacco Use Cessation Medication
    • Bupropion
    • Nicotine
    • Varenicline