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
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
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.
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