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Preventive Services: Intensive Behavioral Therapy (IBT) for Obesity

By:  Find-A-Code
Published:  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: 

HCPCS/CPT Codes

G0447 - Face-to-face behavioral counseling for obesity, 15 minutes
G0473 - Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

ICD-10 Codes

Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44, or Z68.45

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

Frequency

Medicare will pay for up to 22 visits billed with the codes G0447 and G0473, combined, in a 12-month period:

  • 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

 Other Notes

  • 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.


References:

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