CMS Pub. 100-04, ch. 18, § 200.1

For services furnished on or after November 29, 2011, Medicare will cover Intensive Behavioral

Therapy for Obesity. Medicare beneficiaries with obesity (BMI ≥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 are eligible for:

• One face-to-face visit every week for the first month;

• One face-to-face visit every other week for months 2-6;

• 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 as discussed below.

The counseling sessions are to be completed based on the 5As approach adopted by the United

States Preventive Services Task Force (USPSTF.) The steps to the 5As approach are listed

below:

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior

change goals/methods.

2. Advise: Give clear, specific, and personalized behavior change advice, including information

about personal health harms and benefits.

3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s

interest in and willingness to change the behavior.

4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in

achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental

supports for behavior change, supplemented with adjunctive medical treatments when

appropriate.

5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing

assistance/support and to adjust the treatment plan as needed, including referral to more

intensive or specialized treatment.

Medicare will cover Face-to-Face Behavioral Counseling for Obesity, 15 minutes (G0447), Face-to-face behavioral counseling for obesity, group (2-10), 30 minute(s) (G0473), along with 1 of

the ICD-9-CM codes for BMI 30.0-BMI 70 (V85.30-V85.39 and V85.41-V85.45), up to 22

sessions in a 12-month period for Medicare beneficiaries. The Medicare coinsurance and Part B

deductible are waived for this preventive service.

NOTE: Effective for claims with dates of service on or after January 1, 2015, codes G0473 and

G0447 can be billed for a total of no more than 22 sessions in a 12-month period.

A/B MACs (A) and (B) shall note the appropriate ICD-10-CM code(s) that are listed below for

future implementation. A/B MACs (A) and (B) shall track the ICD-10-CM codes and ensure that

the updated edit is turned on when ICD-10 is implemented.

See Pub. 100-03, Medicare National Coverage Determinations Manual, §210.12 for complete

coverage guidelines.