Medicare Adds Obesity Screening and Counseling Coverage

Medicare is adding coverage for preventive services to reduce obesity. This adds to Medicare’s existing portfolio of preventive services that are now available without cost sharing under the Affordable Care Act. Screening for obesity and counseling for eligible patients by primary care providers in settings such as physicians’ offices are covered under this new benefit.

For a patient who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. The patient may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kg) during the first six months of counseling.

Read the final decision on the new national coverage determination for complete details.


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6 Responses to “Medicare Adds Obesity Screening and Counseling Coverage”

  1. Ashley Little says:

    With the intensive behavioral therapy, can liscensed therapists not provide this service? the way it reads only md, and mid level providers can do this? Thank you

  2. Pam Brooks, PCS, CPC says:

    What would be helpful, is direction of how we will need to bill this…..what CPT code, and what specific diags? I guess we have to wait for a Med-Learn Matters article.

  3. Ashley Little says:

    PAM- I agree.. How to bill this specifically. I read the whole article twice and I just cannot believe that licensed counselors and dieticians cannot take part

  4. LuAnn Weis says:

    I was wondering the same thing about the CPT codes OR will Medicare require their won HCPCS for this counseling.

  5. Debbie Harden says:

    Any news on codes yet?

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