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Behavioral counseling key to reimbursements for obesity


Many of our patients seem to be gaining weight, and we are seeing more cases of obesity. Our physician is already spending time discussing risk factors with patients. Is there reimbursement specifically for weight management counseling?


Q: Many of our patients seem to be gaining weight, and we are seeing more cases of obesity. Our physician is already spending time discussing risk factors with patients. Is there reimbursement specifically for weight management counseling?

A: It is important for physicians to discuss risk factors with patients, and obesity is one of the most important. We are keenly aware that the prevalence of and problems associated with obesity are causing major health problems in the United States.

The Centers for Medicare and Medicaid Services (CMS) started reimbursing for obesity counseling in November 2011, when they introduced Healthcare Common Procedure Coding System (HCPCS) code G0447, face-to-face behavioral counseling for obesity, 15 minutes. 

This code reimburses at approximately $25 and is for patients with a body mass index (BMI) of 30 kg/m2 or greater. While many may argue that this reimbursement amount isn’t worth the physician’s time, I would suggest that the need for this type of discussion between a physician and patient is priceless when it comes to a patient’s overall health.

The United States Preventive Services Task Force (USPSTF) considers BMI over 30 kg/m2 a good indication of morbidity and mortality. Behavioral counseling and behavior modification can be an effective combination to produce moderate, sustainable weight loss. 

According to CMS’ National Coverage determination (NCD) for Intensive Behavioral Therapy, NCD 210.12, the therapy for obesity consists of the following:

  • screening for obesity in adults using measurement of body mass index (BMI), calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2);

  • dietary (nutritional) assessment; and

  • intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high-intensity interventions on diet and exercise.

Additionally, the NCD states that the intensive behavioral intervention for obesity should be consistent with the 5-A framework (assess, advise, agree on goals, assist, and arrange support) that has been highlighted by the USPSTF.

Medicare will pay for G0447 up to 22 times in a 12-month period, counted from the date of the first claim. The valid ICD-9 codes are V85.30-V85.39, V85.41-V85.45, and the ICD-10 codes will be Z68.30-Z68.39, Z68.41- Z68.45.

Check with your local Medicare administrative contractor for clarification on the ability to bill more than one unit per visit. Medicare coinsurance and Part B deductible are waived for this service. The patient must be competent and alert at the time of counseling, which may be provided by primary care physicians, advanced practice nurses, and physician assistants.

These services also can be performed by auxiliary personnel when incident-to guidelines are met.

For Medicare beneficiaries with obesity, CMS covers:  one face-to-face visit every week for the first month and one face-to-face visit every other week for months 2 through 6. A weight loss reassessment needs to be performed at the 6-month visit, and those patients who have lost at least three kg during that time period will be eligible for one monthly visit for another 6 months.

Keep in mind also that there are BMI quality measures for which you can receive incentive payments from CMS through its Physician Quality Reporting System program. 


Answers to readers' questions were provided by Renee Stantz a billing and coding consultant for VEI Consulting Services in Indianapolis, Indiana. Send your practice management questions to medec@advanstar.com.


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