How To Use HCPCS Code G0473

HCPCS code G0473 describes face-to-face behavioral counseling for obesity in a group setting, consisting of 2 to 10 individuals, with each session lasting for 30 minutes. This code is used to identify and bill for the specific service of group behavioral counseling aimed at addressing obesity-related issues. In this article, we will delve into the details of HCPCS code G0473, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0473?

HCPCS code G0473 is used to identify and bill for face-to-face behavioral counseling sessions conducted in a group setting for individuals with obesity. The counseling sessions are aimed at addressing the behavioral aspects of obesity and promoting healthier lifestyle choices. This code specifically applies to group sessions consisting of 2 to 10 individuals, with each session lasting for 30 minutes.

2. Official Description

The official description of HCPCS code G0473 is “Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes.” The short description for this code is “Group behave couns 2-10.”

3. Procedure

1. The healthcare provider conducts face-to-face behavioral counseling sessions for a group of individuals with obesity.
2. The group size should range from 2 to 10 participants.
3. Each counseling session should last for a duration of 30 minutes.
4. The provider addresses the behavioral aspects of obesity, including lifestyle choices, eating habits, physical activity, and goal setting.
5. The counseling sessions may involve discussions, educational materials, and practical strategies to promote healthier behaviors and weight management.

4. When to use HCPCS code G0473

HCPCS code G0473 should be used when healthcare providers offer face-to-face behavioral counseling sessions in a group setting to individuals with obesity. It is important to ensure that the group size falls within the range of 2 to 10 participants, and each session lasts for 30 minutes. This code is specifically intended for counseling services focused on addressing the behavioral aspects of obesity.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0473, healthcare providers need to ensure proper documentation of the counseling sessions. The documentation should include:

• Participant information, including their names and unique identifiers
• Date and duration of each counseling session
• Topics covered during the counseling sessions
• Summary of the counseling session, including any goals set or progress made

Providers should also follow the billing guidelines set by the relevant payers, ensuring accurate coding and submission of claims for reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0473 was added to the Healthcare Common Procedure Coding System on January 01, 2015. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in effect since its addition and continues to be used for billing face-to-face behavioral counseling for obesity in a group setting.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services billed under HCPCS code G0473, subject to their respective coverage policies and guidelines. The pricing indicator code for this code is 13, which signifies that the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code is A, indicating that the code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code G0473 should be billed:

1. A healthcare provider conducts a 30-minute group counseling session for 5 individuals with obesity, focusing on behavior modification techniques and goal setting.
2. A registered dietitian leads a group counseling session for 8 individuals with obesity, providing education on healthy eating habits and portion control.
3. A psychologist facilitates a group counseling session for 3 individuals with obesity, addressing emotional eating triggers and stress management techniques.
4. A certified fitness instructor conducts a 30-minute group exercise session for 6 individuals with obesity, promoting physical activity as part of a weight management program.
5. A healthcare provider leads a group counseling session for 10 individuals with obesity, discussing strategies for overcoming barriers to weight loss and maintaining long-term behavior change.