"CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association."
Effective for claims with dates of service November 29, 2011, and later, Medicare beneficiaries with obesity, defined as Body Mass Index (BMI) equal to or greater than 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
Coverage and Limitation
One face-to-face visit every week for the first month;
One face-to-face visit every other week for months 2-6; and
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.
At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss should be performed. To be eligible for additional face-to-face visits occurring once a month for months 7-12, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs.), over the course of the first 6 months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice.
For beneficiaries who do not achieve a weight loss of at least 3kg (6.6 lbs.) during the first 6 months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.
IBT for obesity consists of the following:
1. Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2);
2. Dietary (nutritional) assessment; and,
3. Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.
Effective July 2, 2012, for claims processed with dates of service on or after November 29, 2011, Medicare will pay for G0447 no more than 22 times in a 12-month period.
Medicare will recognize HCPCS code G0447, Face-to-Face Behavioral Counseling for Obesity, 15 minutes. G0447 must be billed along with 1 of the following ICD-9 codes for BMI 30.0 and over.
ICD-9 codes V85.30 - V85.39, V85.41 - V85.45
Effective for services on or after November 29, 2011, Medicare will pay claims for G0447, only when services are submitted by the following provider specialty types found on the provider’s Medicare enrollment record:
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
Place of Service
Effective for services on or after November 29, 2011, Medicare will pay for obesity counseling claims containing HCPCS G0447 only when services are provided with the following POS codes:
11 - Physician’s Office
22 - Outpatient Hospital
49 - Independent Clinic
71 - State or local public health clinic.
Deductible and Coinsurance
Medicare coinsurance and Part B deductible are waived for this service.
Also see Complete list of Screening codes effective for the year 2012
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
Current coding for testing for drugs of abuse relies on a structure of “screening” (known as “presumptive” testing) followed by “confirmat...
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
Myocardial perfusion imaging is being done to determine the significance or the extent of myocardial ischemia (or scar), or to assess my...
Evaluation Codes (CPT Codes 97001 and 97002 for physical therapy) and (CPT Codes 97003 and 97004 for occupational therapy)The initial evaluation identifies the problem or difficulty the patient is having which helps determine the appropriate therapy necessar...
This therapeutic procedure is provided to improve balance, coordination, kinesthetic sense, posture, and proprioception (e.g., proprioc...
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...
Medicare does not currently pay for the Tetanus vaccines as they consider it preventive and it doesn’t happen to be one of the preventive...
TEST CODE DESCRIPTION OLD CPT CODE NEW CPT CODE 6MAM 6 MAM SCREEN RFLX 80101 (HCPCS G0431) 80301 (HC...
Section 4163 of the Omnibus Budget Reconciliation Act of 1990 added §1834(c) of the Act to provide for Part B coverage of mammography sc...