Plump Up Your Bottom Line While Helping Patients Slim Down

February 20th, 2015

CMS recognizes that obesity is a major cause of health problems in the US; and will pay providers to help their patients combat it! 

When a patient has a BMI of 30 kg/m2 or higher a Medicare will reimburse  for up to 22 visits in a year: 

  • One visit per week for the first month
  • One visit every other week between months two and six.
  • And for those patients lose 6.6 pounds during the first six months, one visit per month for the next six months!

When providing services for obestiy counseling to Medicare patients, report one of the following G codes:

  • G0447 (Face-to-face behavioral counseling for obesity, 15 minutes)  (National reimbursement - $26.10)
  • G0473 (Face-to-face behavioral counseling for obesity, group [2-10], 30 minutes)  - One unit is reported for each person in the group! (National reimbursement - $12.51)

The 22 units per year includes both individual and group counseling.

In order to appropriately document care, the Medicare Compliance & Reimbursement Alert says to:

...Keep the “Five A” strategy in mind when completing your documentation to ensure that the following five factors are in your documentation:

1. Assess. Ask the patient about his behavioral health risk and any factors impacting his choice of behavior change goals and methods.

2. Advise. Offer clear and specific personalized behavior change advice, with information about personal health harms and benefits.

3. Agree. Work with the patient to choose treatment goals and methods that the patient will likely be willing to perform.

4. Assist. Help the patient achieve his goals via behavior change techniques like counseling so he can get the skills, confidence and support required to follow the plan, supplemented with adjunctive medical treatments when appropriate.

5. Arrange. Schedule follow-ups to continue to support the patient and adjust the treatment plan when necessary.

For more information on obesity counseling, check the Medicare Claims Processing Manual at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf and the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8874.pdf.

Tags: Preventive Care, Obesity Counseling

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