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Intensive Behavioral Therapy (IBT) for Obesity (NCD 210.12)

Medicare covers intensive behavioral therapy for people with obesity, defined as a body mass index (BMI) of 30 or more.

HCPCS/CPT Codes


G0447 – Face-to-face behavioral counseling for obesity, 15 minutes

G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

ICD-10-CM (ICD-9-CM) Codes


Report one of the following codes:

Z68.30-Z68.39 (V85.30–V85.39), Z68.41-Z68.45 (V85.41–V85.45)

Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44, or Z68.45

Who Is Covered


Medicare beneficiaries:

  • With obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared);
  • Who are competent and alert at the time counseling is provided; and
  • Whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

Frequency


  • First month: one face-to-face visit every week;
  • Months 2 – 6: one face-to-face visit every other week; and
  • Months 7 – 12: one face-to-face visit every month if certain requirements are met

At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.

To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, beneficiaries must have lost at least 3kg.

For beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

Other Notes


  • At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.
  • To be eligible for additional face-to-face visits occurring once a month for months 7–12, Medicare beneficiaries must have lost at least 3 kg during the first 6 months.
  • For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

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