Obesity behavioral therapy If you have a body mass index (BMI) of 30 or more, Medicare Part B (Medical Insurance) covers obesity screenings and behavioral counseling to help you lose weight by focusing on diet and exercise.
Full Answer
Does Medicare Part B cover weight loss counseling?
Medicare Part B (medical insurance) covers obesity screenings and behavioral therapy for beneficiaries with a body mass index (BMI) of 30 or more. Your weight loss counseling and screenings are covered in full if received from a primary care doctor who accepts Medicare assignment.
Does Medicare Part B cover obesity screenings?
Medicare Part B (Medical Insurance) covers obesity screenings and behavioral counseling if you have a body mass index (BMI) of 30 or more. You pay nothing for this service if your primary care doctor or other qualified primary care practitioner accepts Assignment.
Does Medicare cover weight loss screenings?
Although Medicare coverage doesn’t usually provide benefits for weight loss programs on their own, if your doctor deems a screening service medically necessary and the screening includes measuring things like weight and body mass index, these screenings will likely be covered under Medicare Part B.
Can I join a weight loss program on Medicare?
Medicare has not formally approved any weight loss programs or fad diets. Speak to your doctor before joining a new program. Here is some information about popular weight loss programs. Recently, private Medicare Advantage plans have been given the ability to cover more benefits, and dietary programs like this could be one of them.
Does Medicare Part B cover weight loss programs?
Original Medicare (Part A and Part B) does cover weight loss programs, therapy, screenings and surgery if your doctor or health care provider decides that treatment is medically necessary. Medicare Advantage (Part C) plans also cover weight loss programs when they're medically necessary.
Does Medicare have a weight loss program?
Medicare doesn't offer weight loss services for all enrollees unless it's necessary for a medical procedure, such as to prepare for bariatric surgery, or as part of your preventive care.
How do you bill for weight management?
Medical nutritional therapy codes (97802, 97803, S9470) may be billed when counseling patients on obesity or weight management. These codes are compatible with any diagnosis but are most appropriate or intended for illness or disease-related diagnoses such as obesity or diabetes.
What does Medicare consider morbid obesity?
It is characterized by a body mass index (BMI) equal to or greater than 35kg/m² (or a BMI of 35 or higher). Coverage will be provided for surgery for morbid obesity when it is determined to be medically necessary because the medical criteria and guidelines shown below are met.
Does Medicare cover treatment for obesity?
In cases of severe obesity (BMI of 35 or higher), Medicare covers bariatric surgery if it's determined by your doctor to be medically necessary. In order to secure coverage, you'll typically need to have a qualifying BMI and at least one underlying obesity-related health condition, such as diabetes or heart disease.
What is the most successful weight loss program?
WW, formerly Weight Watchers, is one of the most popular weight loss programs worldwide. While it doesn't restrict any food groups, people on a WW plan must eat within their set number of daily points to help them reach their ideal weight ( 24 ).
Can you bill for obesity?
At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be documented in the health care record. Obesity screening and counseling is one of a number of distinct preventive services mandated by national and state regulations [US Dept. of Labor].
Is there a CPT code for BMI?
Reporting Body Mass Index on Claims For the additional reimbursement, CPT (Current Procedural Terminology) Category II procedure code 3008F (Body mass index, documented) is required on the claim in addition to an office visit procedure code.
How do you bill for obesity counseling?
Preventative Counseling (CPT 99401-9941) The standard obesity medicine behavioral counseling codes are 99401-99412. These codes are used to report services for the purpose of promoting health and preventing illness. Typically, the 5-A's approach i.e., ask, advise, assess, assist, and arrange is used.
What is obesity counseling?
Intensive behavioral therapy is a treatment for obesity. Through this treatment, you learn how to change your eating and exercise habits. This helps you lose weight. Intensive behavioral therapy can work very well. It targets poor habits that lead to obesity.
What is obesity screening?
An obesity screening is used to find out if you or your child is at an unhealthy weight. If the screening shows that you or your child is overweight or has obesity, your provider will check to see if there is medical issue causing the excess weight.
What is the treat and reduce obesity act?
The Treat and Reduce Obesity Act expands Medicare to cover evidence-based obesity treatment options by allowing the Centers for Medicare & Medicaid Services to expand Medicare Part D coverage to include FDA-approved anti-obesity medications and expanding the Intensive Behavioral Therapy benefit by allowing additional ...
How much does Medicare pay for bariatric surgery?
If your bariatric surgery is performed in an outpatient setting, Medicare Part B will help cover your costs after you meet your Part B deductible ( $198 per year in 2020). After you meet your deductible, you are typically responsible for paying 20 percent of the Medicare-approved amount for your weight loss surgery.
What is Medicare Part B?
Medicare Part B (medical insurance) covers obesity screenings and behavioral therapy for beneficiaries with a body mass index (BMI) of 30 or more. These weight loss programs can include: An initial BMI screening. Dietary assessments.
What is a diet assessment?
Dietary assessments. Counseling to help beneficiaries focus on diet and exercise in an effort to lose weight. Your weight loss counseling and screenings are covered in full if received from a primary care doctor who accepts Medicare assignment. According to America’s Health Rankings, 28 percent of Americans over the age of 65 are considered obese ...
How long does Medicare take to train?
The initial six months of training are followed by six additional months of less intensive follow-up sessions and 12 more months of ongoing maintenance sessions. Medicare beneficiaries who meet the requirements for the program pay nothing for the service.
What is the fasting glucose for Medicare?
You have a hemoglobin A1c test result between 5.7 and 6.4 percent, a fasting plasma glucose of 110 to 125 mg/dL or a 2-hour plasma glucose of 140 to 199 mg/dL within 12 months before attending the first core session of the prevention program.
What percentage of Americans are obese?
According to America’s Health Rankings, 28 percent of Americans over the age of 65 are considered obese (having a body mass index of 30 or higher) in 2018. 1 Two of the main contributors to senior obesity are slowing metabolism and decreased activity.
Does Medicare cover nutrition therapy?
Medicare covers nutrition therapy for some beneficiaries. Medicare Part B covers medical nutrition therapy (MNT) for beneficiaries with diabetes or kidney disease and beneficiaries who received a kidney transplant in the past 36 months. Medicare nutrition therapy services can include:
What is a Weight Loss Program?
A conventional weight loss program is one that combines nutritional counseling, exercise, and behavioral therapy to address weight loss.
Does Medicare Cover Weight Loss Programs?
In most cases, Medicare doesn’t cover weight loss programs, weight loss services, or weight loss medications. This includes:
What Are Weight Loss Preventive Services?
Original Medicare may provide coverage for obesity behavioral therapy, medical nutrition therapy, and some bariatric surgery procedures. However, eligibility requirements will vary for each service.
Do Medicare Advantage Plans Cover Weight Loss Programs?
A Medicare Advantage plan, also known as an MA plan or Medicare Part C, has the same covered services as Original Medicare since Medicare Part C bundles both Medicare Part A and Medicare Part B. That said, a Medicare Advantage plan typically has additional benefits and coverage.
Do Other Medicare Supplement Plans Cover Weight Loss Programs?
Medicare supplement plans, also known as Medigap or MedSupp, are policies that “ fill in the gaps” of Original Medicare, providing a more comprehensive health care plan. Like MA plans, Medigap plans may help cover the costs for weight management services and fitness programs.
Tips for Weight Loss
According to the National Institute of Diabetes and Digestive and Kidney Diseases, there are a number of best practices for choosing a weight loss program.
What is bariatric surgery?
This surgery may be bariatric, meaning the surgery is designed specifically to address health issues caused by excess weight, or it may be a different surgery requiring weight loss as a prerequisite to get healthy enough to have the operation and recover from it.
What is weight loss program?
Weight loss programs come in a variety of formats, and many are geared toward losing weight. These programs often require strict adherence to a specific diet or exercise routine, but some also push specialized dietary supplements that are proprietary to the company supporting the program.
What is weight loss counseling?
Weight loss counseling services may also be included in this group if the counseling is part of a treatment plan to prevent or fight off a medical condition being caused in whole or in part by obesity or associated conditions like diabetes or hypertension.
Is obesity a problem?
Obesity is a major concern among Americans at any age as it can lead to a wide range of medical complications affecting various systems and organs. From heart disease to joint deterioration, excess weight has a detrimental effect on almost every part of the body, and unfortunately, the older we get, the harder it can be to lose excess weight.
Can seniors on Medicare have mobility issues?
When you add in the fact that many seniors and people with disabilities on Medicare have mobility issues that prevent them from being able to partake in regular exercise, you have a recipe for frustration and potentially serious health consequences.
Does Medicare cover weight loss after surgery?
Medicare Part B covers these programs because they are outpatient in nature, but if a weight loss program is part of a stay in a skilled nursing facility after surgery, Medicare Part A may cover some of the cost.
What is the BMI for Medicare?
Obesity Screenings & Counseling. As long as you have Medicare Part B and have a BMI (body mass index) of 30 or higher, you are eligible for obesity screenings and counseling. The National Heart, Lung, and Blood Institute has a free BMI calculator on its website, but a doctor’s screening will be much more accurate.
What is the least invasive gastric banding procedure?
A laparoscopic gastric banding procedure is the least invasive. A soft, silicone ring with an expandable balloon is implanted at the top of the stomach. It basically creates two compartments for the stomach. The patient will only eat enough food to fill the top part. Over time, the food will pass through into the second (original) compartment of the stomach and will be digested.
What is the most common type of bariatric surgery?
Types of Bariatric/Weight-Loss Surgeries. The most common bariatric surgeries are a gastric bypass, a sleeve gastrectomy, an adjustable gastric band, and a biliopancreatic diversion with duodenal switch. Generally, bariatric surgery is recommended for people with: A BMI between 35 and 39.9. A health condition such as:
How long does it take to lose weight after a sleeve gastrectomy?
The duodenal switch often results in 60-80 percent excess weight loss within two years.
How much weight loss is a sleeve gastrectomy?
About 75% of the stomach is removed, causing it to form a “sleeve” shape. This procedure is used for people with a BMI over 40. It often results in 60% weight loss.
Does Medicare cover weight loss?
Medicare coverage for weight loss can include obesity screenings, obesity counseling sessions, nutritionists, and qualified dietitians. It may even include gym membership discounts. If you think eating well and exercising is too expensive, think again: your Medicare plan can cover it!
Does Medicare cover diabetes prevention?
Additionally, Medicare can cover your participation in the 16-session Diabetes Pre vention Program if you: Have a BMI over 25 (23 if you are Asian) Have never been diagnosed with either diabetes or ESRD. Have not participated in this program before .
The right weight loss program can help you make healthy lifestyle changes
Original Medicare covers a variety of services intended to help you maintain a healthy weight, but it generally does not cover weight loss programs. It does, however, cover a variety of services designed to help you live a healthier, longer life. Medicare may also help pay for bariatric weight loss surgery if you qualify.
What Weight Loss Services Does Original Medicare Cover?
Medicare beneficiaries are highly encouraged to take advantage of two screenings, both covered 100 percent:
Do Medicare Advantage Plans Cover Weight Loss Programs?
Medicare Part C, commonly known as Medicare Advantage, combines your Medicare Parts A and B benefits in a single health insurance plan. Federal guidelines established by the Centers for Medicare & Medicaid Services (CMS) require all Advantage plans to provide the same benefits as Original Medicare.
What is the BMI for free counseling?
To qualify for free counseling, your body mass index — called BMI — must be 30 or higher — a score that currently applies to more than a third of Medicare beneficiaries, according to Medicare officials. As a first step, you can use an online BMI calculator, such as the one provided by AARP.
What is the billing code for intensive behavioral therapy for obesity?
So you need to know that the program is officially called “Intensive Behavioral Therapy for Obesity,” and doctors should use billing code G0447 to submit to Medicare for reimbursement. If necessary, refer them to Medicare’s guidance for physicians on this topic.
How often does Medicare cover counseling?
The Medicare counseling coverage includes: One session every week for the first month. One session every other week for months 2 through 6. Monthly sessions for a further six months (7 through 12) if you have lost at least 6.6 pounds by the sixth month.
How long do you have to wait to get Medicare to pay you?
But you have to wait six months before Medicare will pay for you to try again, officials say. There is no limit to how many attempts you can make, provided that your body mass is still 30 or greater and that six months have gone by since the last attempt.
Decision Summary
The Centers for Medicare and Medicaid Services (CMS) has determined the following:
Decision Memo
The Centers for Medicare and Medicaid Services (CMS) has determined the following:
Bibliography
http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm U.S. Preventive Services Task Force, Grade Definitions.
