Institutional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15)

by  Jared Staheli
July 7th, 2015

Effective for claims with dates of service on and after November 29, 2011, providers may use the following types of bill (TOB) when submitting HCPCS code G0447: 13x, 71X, 77X, or 85X. Service line items on other TOBs shall be denied.

Effective for claims with dates of service on and after January 1, 2015, providers may use the following types of bill (TOB) when submitting HCPCS code G0473: 13x or 85X. Service line items on other TOBs shall be denied.

The service shall be paid on the basis shown below:

• Outpatient hospitals – TOB 13X - based on Outpatient Prospective Payment System (OPPS)

• Critical Access Hospitals (CAHs) - TOB 85X – based on reasonable cost

• CAH Method II – TOB 85X - based on 115% of the lesser of the Medicare Physician Fee Schedule (MPFS) amount or actual charge as applicable with revenue codes 096X, 097X, or 098X.

NOTE: For outpatient hospital settings, as in any other setting, services covered under this NCD must be provided by a primary care provider.

References:

Institutional Billing Requirements for Policy for Intensive Behavioral Therapy for Obesity (Rev. 3232, 01-05-15). (2015, July 7). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/institutional-billing-requirements-for-policy-for-intensive-behavioral-therapy-for-obesity-rev-3232-01-05-15-27083.html

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