Does Medicare Part B cover obesity behavioral therapy?
Obesity behavioral therapy Medicare Part B (Medical Insurance) covers obesity screenings and behavioral counseling if you have a body mass index (BMI) of 30 or more.
How much does Medicare pay for counseling for obesity?
The national Medicare fee schedule amount is about $26. The service consists of screening for obesity, dietary assessment and intensive behavioral counseling and behavioral therapy, for eligible patients.
What is the HCPCS code for behavioral counseling for obesity?
Behavioral counseling for obesity, HCPCS code G0447 Behavioral counseling for obesity, HCPCS code G0447 Medicare pays for ongoing face-to-face behavioral counseling for patients with a BMI of ≥ 30, who are alert and able to participate in counseling.
What is included in the service for patients with obesity?
The service consists of screening for obesity, dietary assessment and intensive behavioral counseling and behavioral therapy, for eligible patients. The patient must have a BMI of ≥ 30 to be eligible for the service.
What is annual BMI counseling?
Register. Body mass index (BMI) is a measure of body fat in adults. BMI screenings and follow-up behavioral counseling can help you lose weight if your BMI is high. Eligibility. Medicare Part B covers BMI screenings and behavioral counseling to help you lose weight if you are obese.
Does Medicare pay for weight loss counseling?
Obesity screenings and counseling If you have a body mass index (BMI) of 30 or above, Medicare covers obesity screenings and behavioral counseling. These preventive services must be performed by your doctor or primary care physician in a doctor's office or primary care setting.
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 physical therapy for obesity?
What Are Weight Loss Preventive Services? Original Medicare may provide coverage for obesity behavioral therapy, medical nutrition therapy, and some bariatric surgery procedures.
How many visits does Medicare allow for behavioral counseling for obesity?
Medicare covers obesity screenings and behavioral counseling for beneficiaries with a body mass index of 30 or more. You can receive up to 22 counseling visits within a 12-month period if you meet certain program requirements.
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 behavioral therapy?
What is intensive behavioral therapy for obesity? 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.
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.
Is nutritionist covered by Medicare?
Medicare doesn't cover a nutritionist for the sole purpose of weight loss. However, if you are diabetic and get a referral from your doctor, you will be able to see a Registered Dietician and receive full coverage from Medicare.
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 ...
Does Medicare pay for Phentermine?
No. In general, Medicare prescription drug plans (Part D) do not cover this drug.
Does medical cover weight loss programs?
What kind of weight loss treatments do insurers cover? The Affordable Care Act requires that most health insurers cover obesity screening and counseling as preventive care for adults and children. Diet counseling is also available for adults at higher risk for chronic disease.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Transmittal Information
02/2012 - Effective for claims with dates of service November 29, 2011, and later, Medicare beneficiaries with obesity (BMI andNo.8805;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.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
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.