September 1st, 2017
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Intensive Behavioral Therapy (IBT) for Obesity:
|G0447 -||Face-to-face behavioral counseling for obesity, 15 minutes|
|G0473 -||Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes|
Who Is Covered
Medicare beneficiaries when all of the following are true:
- Obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared)
- Competent and alert at the time counseling is provided
- Counseling furnished by a qualified primary care physician or other primary care practitioner in a primary care setting
- First month: one face-to-face visit every week
- Months 2–6: one face-to-face visit every other week
- Months 7–12: one face-to-face visit every month if certain requirements are met
Medicare Beneficiary Pays
- Copayment/coinsurance waived
- Deductible waived
- At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.
- To be eligible for additional face-to-face visits occurring once a month for months 7–12, Medicare beneficiaries must have lost at least 3 kg.
- For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.
Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.
Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.