Thank you for your inquiry about CMS138v11. This measure (CMS138v11) is based on The US Preventive Services Task Force (USPSTF) which recommends that adults that use any type of tobacco product receive cessation intervention: either counseling and or pharmacotherapy. The USPSTF references the US Food and Drug Administration definition of tobacco, which includes e-cigarettes, hookah pens and other electronic nicotine delivery systems. E-cigarettes and/or Vaping products usually contain nicotine, which is the addictive ingredient in tobacco. However, E-cigarettes and vaping products are not always classified as "smokeless tobacco" since substances other than tobacco can also be used in these products.