CMS Opens NCA for Behavioral Therapy for Obesity

The Centers for Medicare & Medicaid Services (CMS) has initiated a national coverage analyses (NCA) on intensive behavioral therapy for obesity (IBTO). The agency is considering adding this screening to the list of preventive services already covered by Medicare, such as Pap smear and screening pelvic exams, screening mammograms, colorectal cancer screening tests, and diabetes screening tests.

The tracking sheet for this NCA doesn’t indicate an age group, but the U.S. Preventive Services Task Force (USPSTF) has recommended, with a grade B, obesity screening and counseling for adults since December 2003 and for children ages 6 and older since January 2010.

“A number of techniques, such as bioelectrical impedance, dual-energy X-ray absorptiometry, and total body water can measure body fat, but it is impractical to use them routinely,” the USPSTF states in its Screening for Obesity in Adults: Recommendations and Rationales. “Body Mass Index (BMI), which is simply weight adjusted for height, is a more practical and widely-used method to screen for obesity.” Persons with a BMI between 25 and 29.9 are overweight and those with a BMI of 30 and above are considered obese. The National Institutes of Health (NIH) provides a BMI calculator and a table.

In 1998, the National Heart, Lung and Blood Institute (NHLBI), in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, released the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, the first federal guidelines on this subject. Review and revision of the guidelines is currently underway.

Public comment on the appropriate frequency of this therapy and those qualified to provide it, based on documentation from the medical literature, current clinical practice guidelines, or USPSTF recommendations is being accepted until April 10. The proposed decision memo due date is Sept. 11.

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