For services furnished on or after November 29, 2011, Medicare will cover Intensive Behavioral Therapy for Obesity. Medicare beneficiaries with obesity (BMI ≥30 kg/m2 ) who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting are eligible for:
• One face-to-face visit every week for the first month;
• One face-to-face visit every other week for months 2-6;
• 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 as discussed below.
The counseling sessions are to be completed based on the 5As approach adopted by the USPSTF. The steps to the 5As approach are listed below:
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.
Medicare will cover Face-to-Face Behavioral Counseling for Obesity, 15 minutes (G0447), Face-to-face behavioral counseling for obesity, group (2-10), 30 minute(s) (G0473), along with 1 of the ICD-9 codes for BMI 30.0-BMI 70 (V85.30-V85.39 and V85.41-V85.45), up to 22 sessions in a 12-month period for Medicare beneficiaries. The Medicare coinsurance and Part B deductible are waived for this preventive service.
Contractors shall note the appropriate ICD-10 code(s) that are listed below for future implementation. Contractors shall track the ICD-10 codes and ensure that the updated edit is turned on when ICD-10 is implemented.
|Z68.30||BMI 30.0-30.9, adult|
|Z68.31||BMI 31.0-31.9, adult|
|Z68.32||BMI 32.0-32.9, adult|
|Z68.33||BMI 33.0-33.9, adult|
|Z68.34||BMI 34.0-34.9, adult|
|Z68.35||BMI 35.0-35.9, adult|
|Z68.36||BMI 36.0-36.9, adult|
|Z68.37||BMI 37.0-37.9, adult|
|Z68.38||BMI 38.0-38.9, adult|
|Z68.39||BMI 39.0-39.9, adult|
|Z68.41||BMI 40.0-44.9, adult|
|Z68.42||BMI 45.0-49.9, adult|
|Z68.43||BMI 50.0-59.9, adult|
|Z68.44||BMI 60.0-69.9, adult|
|Z68.45||BMI 70 or greater, adult|
See Pub. 100-03, Medicare National Coverage Determinations Manual, §210.12 for complete coverage guidelines.
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.
If you would like a specific article written on a medical coding and billing topic, please Contact Us.
Find A Code, LLC
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)