- Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
- Related Articles
- Medicare Preventive Services Resource Guide
- The Annual Wellness Visit
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Intensive Behavioral Therapy for Obesity
In 2003, the United States Preventive Services Task Force found good evidence that BMI “is reliable and valid for identifying adults at increased risk for mortality and morbidity due to overweight and obesity.” The USPSTF also found fair to good evidence that high-intensity counseling, combined with behavioral interventions in obese adults “produces modest, sustained weight loss.”
Intensive Behavioral Therapy
- Screening for obesity in adults
- Measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (BMI ≥ 30 kg/m2 )
- Dietary (nutritional) assessment
- Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise
- Should be consistent with 5-A framework highlighted by USPSTF
5-A Framework/Approach
- Assess
- Ask about, assess behavioral health risks and factors affecting choice of behavior change goals/methods
- Advise
- Give clear, specific, personalized behavior change advice, including information about personal health harms and benefits
- Agree
- Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change behavior
- Assist
- Using behavior techniques, 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
- Arrange
- Schedule follow-up contacts to provide ongoing assistance and support. Adjust the treatment plan as needed, including referrals to more intensive or specialized treatment
Coverage Criteria
- Covered when screened positive for obesity with BMI ≥ 30 kg/m2
- Patient must be competent and alert at time counseling is provided
- A maximum of 22 IBT for obesity sessions can be covered in a 12-month period
- One face-to-face visit every week for the first month
- One face-to-face visit every other week for months two through six
- At the six month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed
- For beneficiaries who do not achieve a weight loss of at least 3 kg during the first six months of intensive therapy, a reassessment of their readiness to change and BMI measurement is appropriate after an additional six month period
- One face-to-face visit every month from months seven through twelve
- Only if beneficiary achieved weight reduction of at least 6.6 pounds (3 kg) during the first six months of counseling
HCPCS Coding
- G0447: Face-to-face behavioral counseling for obesity, 15 minutes
- G0473: Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes
Diagnosis Coding
- 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
Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service, and contact your Medicare Administrative Contractor (MAC) for guidance.
Documentation Requirements
- Medical records must document all coverage requirements including determination of weight loss at six-month visit
Who Can Perform/Primary Care Settings Defined
- 01 ‒ General Practice
- 08 ‒ Family Practice
- 11 ‒ Internal Medicine
- 16 ‒ Obstetrics/Gynecology
- 37 ‒ Pediatric Medicine
- 38 ‒ Geriatric Medicine
- 50 ‒ Nurse Practitioner
- 89 ‒ Certified Clinical Nurse Specialist
- 97 ‒ Physician Assistant
- 11 ‒ Physician’s Office
- 19 ‒ Off Campus-Outpatient Hospital
- 22 ‒ On Campus-Outpatient Hospital
- 49 ‒ Independent Clinic
- 71 ‒ State or Local Public Health Clinic
Cost Sharing
- Copayment/coinsurance waived
- Deductible waived
Reimbursement
- MPFS: Fee Schedule Lookup
Nonparticipating Providers
- Nonparticipating reduction applies
- Limiting charge provision applies
Common Claim Denials
- Beneficiary received more than 22 IBT for obesity sessions previous 12 months
- Beneficiary received IBT for obesity outside of primary care setting
- This diagnosis is not covered
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 200
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, Section 210.12
- U.S. Preventive Services Task Force
- MLN® Educational Tool: Medicare Preventive Services
Reviewed 10/12/2023