Medicare now pays for obesity screening and behavioral therapy as part of its coverage for preventive services. It is estimated that approximately 72 million American adults, which include at least one third of Medicare recipients, are obese. The healthcare costs associated with this group is around $325 billion a year. Medicare and most other health insurance plans are required by the Affordable Care Act to cover many preventive services, including intensive counseling and behavioral interventions, completely without cost-sharing on the part of the patients. This is with a view to encourage sustained weight loss.
Obese Medicare beneficiaries can consult their primary care physician for one face-to-face visit every week for the first month, for which they will be reimbursed. After this, for the next five months, Medicare will reimburse one face-to-face visit every other week. Medicare will pay for once-a-month face-to-face visits with the physician for six more months, provided the patient loses at least 6.6 lbs over the first six months. Medicare advises physicians to use the strategy commonly adopted in the case of smoking cessation treatment – this is the “five As” that signify “ask, assess, advise, assist and arrange.” This strategy includes evaluation of health risks, counseling about behavior change and agreement about objectives and strategies. Physicians are expected to provide complete support and ongoing assistance to patients.
Obesity Codes
For a 15-minute visit involving Medicare patients, practices must use the HCPCS code G0447 along with the correct ICD-9 code ranging from V85.30 to V85.45, on the basis of the BMI.
- BMI of 30 to 30.9 — Code V85.30
- BMI of 31.0-31.9 — Code V85.31
- BMI of 70 or more — Code V85.45
Visits shorter than 15 minutes cannot be billed. Counseling can be provided by primary physicians, physician assistants and advanced practice nurses. It is important that the patient is alert and competent at the time of counseling.
Note the Following Points
- Medicare does not allow billing of other services that is provided on the same day as the obesity counseling visit.
- Private payers may allow this, which you need to check with them. Usually the CPT codes to be used are 99401 (for a 15-minute risk-reduction counseling session), and 99402 (for a 30-minute session).
- For patients with commercial insurance, you have to use the ICD-9 code V70.0
The move of the government is expected to encourage more obese people to try and lose weight. This is important because even a small weight loss of 5% to 7% can bring about considerable improvement in health.
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