Therapy Rules for Obesity Updated

The Centers for Medicare & Medicaid Services (CMS) recently informed contractors of an ICD-10 code range revision to previously communicated coverage for intensive behavioral therapy (IBT) for obesity.

Transmittal 2421 reiterates that beginning Nov. 29, 2011, Medicare beneficiaries with a body mass index (BMI) of 30 who are competent and alert at the time of counseling from a primary care physician can receive the following services without Medicare co-insurance or Part B deductible:

  • 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

At the six-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 seven to 12, beneficiaries must have achieved a reduction in weight of at least 6.6 pounds over the course of the first 6 months of intensive therapy. This must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 6.6 pounds during the first six months of intensive therapy, a reassessment of their readiness to change and BMI is appropriate after an additional six-month period.

The revision is in business requirement 7641-04.1.3: For BMI 30.0 and over, ICD-10 codes are Z68.30-Z68.39.9 and Z68.41-Z68.45.



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