Intensive Behavioral Therapy

New Screening code G0447 for Intensive Behavioral Therapy (IBT) for Obesity

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.

G0447 Billing Guidelines

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.

Reassessment

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 Behavioral 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

Speciality Types For G0447

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 reassessment Service Codes

Medicare will pay for obesity counseling claims containing HCPCS G0447 only when services are provided with the following POS codes:

POS 11 – Physician’s Office

POS 22 – Outpatient Hospital

POS 49 – Independent Clinic

POS 71 – State or local public health clinic.

Reference: https://www.cms.gov/MLNMattersArticles/Downloads/MM7641.pdf

Also see Complete list of Screening codes effective for the year 2012

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