Medicare To Pay for Behavioral Therapy for Obesity

December 5th, 2011

Medicare will now pay for Intensive Behavioral Therapy for patients with obesity.

According to Medicare, obesity is defined as a BMI of 30 kg/m2.  This counseling is not subject to deductibles nor coinsurance.

Medicare will pay for:

  • One face-to-face visit every week for the first month;
  • One face-to-face visit every other week for months 2-6; and
  • One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement during the first 6 months.

According to MLN Matters MM7641:

Effective for claims with dates of service on or after November 29, 2011, Medicare will recognize HCPCS code G0447, Face-to-Face Behavioral Counseling for Obesity, 15 minutes.

G0447 must be billed along with 1 of the ICD-9 codes for BMI 30.0 and over (V85.30-V85.39, V85.41-V85.45).

IBT for obesity consists of the following:

  1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2)
  2. Dietary (nutritional) assessment; and,
  3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.

Intensive behavioral intervention for obesity should be consistent with the 5-A framework:

  1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

This service will only be paid to the following specialty types:

01 - General Practice

08 - Family Practice

11 - Internal Medicine

16 - Obstetrics/Gynecology

37 - Pediatric Medicine

38 - Geriatric Medicine

50 - Nurse Practitioner

89 - Certified Clinical Nurse Specialist

97 - Physician Assistant

Services, however, may be rendered by appropriate auxilliary personnel.

Payment for the 15 minute IBT session will be $22 to $25 dollars depending on jurisdiction and place of service.



Tags: Obesity, Preventive Services, IBT


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