Medicare covers behavioral counseling sessions to help you lose weight. This counseling may be covered if you get it in a primary care setting (like a doctor's office). You need to get it in this setting so it can be coordinated with your other care and a personalized prevention plan. Talk to your primary care doctor or practitioner to find out more.

Who Is Covered

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

   • 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

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 Codes

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

Frequency

   • First month: one face-to-face visit every week;

   • Months 2 – 6: one face-to-face visit every other week;

   • Months 7 – 12: one face-to-face visit every month if certain requirements are met

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

Note: 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.

Note: 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.

Medicare Beneficiary Pays

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

References