Medicare does not allow the billing of other services performed on the same day as an obesity counseling CPT CODE visit.
CPT Codes For Screening Services
The comprehensive nature of a preventive medicine code reflects an age and gender appropriate examination. When a “Screening code is billed with a preventive medicine code” on the same date of service by the Same Specialty Physician or Other Health Care Professional, “only the preventive medicine code is reimbursed”.Obesity counseling is not separately payable with another encounter/visit on the same day. For services that contain HCPCS code G0447 CPT Code with another encounter/visit with the same date of service, the service line with HCPCS G0447 CPT Code will be denied.This intensive behavioral therapy service is considered to be included in the payment/allowance of other encounter services provided on the same date of service.
This does not apply for Initial Preventative Physical Examination (IPPE) claims, claims containing modifier 25 indicating a significant and separate E/M service as distinct from the obesity counseling
For eligible adult health plan members with obesity, defined as Body Mass Index (BMI) equal to or greater than 30 kg/m2, optum will align reimbursement with Medicare including:
- 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 member meets the 3kg (6.6 lbs.) weight loss requirement during the first 6 months.]
For adult members who do not achieve a weight loss of at least 3 kg (6.6 pounds) 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.
These visits must be provided by a qualified health care provider.
For eligible children and adolescent (6-18 years) health plan members with overweight, defined as having an age/gender-specific BMI at or above the 85th percentile, Optum will align reimbursement with the recommendations of the U.S. Preventive Services Task Force.
CPT Codes For Obesity Screening & Counseling
- CPT 99401 is defined as: ‘Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes.’
- CPT 99402 is defined as: ‘Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes.’
- CPT G0446 is defined as ‘Annual, face-to-face intensive behavioral counseling (IBT) for cardio-vascular disease (CVD), individual, 15 minutes’
- CPT G0447 is defined as: ‘Face-to-face behavioral counseling for obesity, 15 minutes’
- CPT G0473 is defined as: ‘Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.‘
Couseling Servicing Codes
CPT 0403T, CPT 99401, CPT 99402, CPT 99403, CPT 99404, CPT 99406, CPT 99407, CPT 99408, CPT 99409, CPT 99411, CPT 99412, CPT G0296, CPT G0396, CPT G0397, CPT G0443, CPT G0445, CPT G0446, CPT G0447, CPT G0473, CPT H0005, CPT S0257, CPT S0265, CPT S9470, CPT T1006, CPT T1027.
Preventive Medicine Services include counseling.
When counseling service codes are billed with a preventive medicine code on the same date of service by the Same Specialty Physician or Other Health Care Professional, only the preventive medicine code is reimbursed.